摘要
目的 观测不同剂量的维库溴铵对腹腔镜胆囊切除术中呼吸动力学的影响,以评价其是否对CO2气腹所致的呼吸动力学紊乱具有防治作用。方法 择期行腹腔镜胆囊切除术患者63例,随机分为维库溴铵1×ED95(Ⅰ组)、2×ED95(Ⅱ组)、3×EB95(Ⅲ组)三组,每组21例。分别于气腹前、静注维库溴铵前、静注此药后5、10、15、20、25、30及35min,监测通气功能、呼吸动力学参数。结果CO2气腹前、气腹后(静注维库溴铵前)及静注3种不同剂量维库溴铵后各时点及三组间吸、呼气潮气量、分钟通气量、呼吸频率、吸、呼气峰流速、PEEP、内源性PEEP、压力-时间乘积、吸气时间比值及频率/潮气量比值的变化无显著性(P>0.05)。CO2气腹后,气道平均压,食道压(胸腔内压),吸气峰压,呼吸驱动力,气道阻力,呼吸机做功较气腹前显著增高或增加;动态顺应性显著下降(P<0.05);与CO2气腹后静注维库溴铵前相比较,静注不同剂量维库溴铵后各时点及三组间各时点此类呼吸动力参数的变化均无显著性(P>0.05)。结论 在腹腔镜胆囊切除术中及机械通气的条件下,CO2气腹主要影响呼吸动力学参数,而不同剂量的维库溴铵对此类呼吸动力学的紊乱无防治作用。
Objective To investigate the effects of different doses of vecuronium on ventilatory function and mechanics of breathing during elective laparoscopic cholecystectomy. Methods Sixty-three ASA Ⅰ - Ⅱ patients aged 29-57 yr were randomly divided into 3 groups of twenty-one: group Ⅰ received vecuronium 1 × ED95 , group Ⅱ 2 × ED95 and group Ⅲ 3 × ED95 . Patients with respiratory disease were excluded. The patients were premedicated with intramuscular scopolamine 0.3 mg and oral diazepam 0.1 mg· kg-1 . Anesthesia was induced with fentanyl 2μg· kg-1 , propofol 2 mg·kg-1 and succinylcholine 1.5 mg· kg-1 and maintained with 1.0%-1.5% isoflurance and intermittent iv boluses of propofol 1 mg·kg-1 when needed. Vecuronium 1 × ED95 (group Ⅰ ) or 2 × ED95 (group Ⅱ ) or 3 × ED93 ( group Ⅲ ) was given iv after succinylcholine when TOF showed that T1 > 70% . The patients were mechanically ventilated. VT was set at 10 ml· kg-1 and respiratory rate at 12 bpm. End-tidal PCO2 was maintained at 30-35 mm Hg. End-tidal PCO2, SpO2, ECG and BP were continuously monitored. The respiratory function and mechanics were measured using respiratory monitor CP-100 (BICORE) before and after pneumoperitoneum (intra-abdominal pressure reached 15 mm Hg) and 5,10,15,20,25,30,35 min after vecuronium. The respiratory parameters measured included inspiratory and expiratory VT ( VTi, VTe) , minute ventilation (VE), respiratory rate (RR), peak inspiratory and expiratory flow rate (PIFR,PEFR), PEEP, auto-PEEP, pressure-time product (PTP), inspiratory-time ratio (TI/TTOT ), rate/VT ratio, average airway pressure (PAWM), esophageal pressure (PES), peak inspiratory pressure (PIP), dynamic compliance (CDyn), airway resistance (RAw ) and work of breathing. Results There was no significant difference in the effect of different doses of vecuronium on respiratory function and mechanics including all parameters measured at all time points among the three groups. Mean airway pressure, esophageal pressure peak inspiratory pressure, airway resistance and work of breathing increased significantly but dynamic compliance decreased significantly after CO2 penumoperitoneum. Conclusion Intra-abdominal CO2 insufflation significantly attect respiratory mecnanics. me effect of pneumoperitoneum on respiratory mechanics can not be prevented or attenuated by increasing the dose of muscle relaxant.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2003年第2期87-90,共4页
Chinese Journal of Anesthesiology
关键词
腹腔镜胆囊切除术
剂量
维库溴铵
呼吸动力学
通气功能
Vecuronium
Cholecystectomy, laparoscopic
Respiratory function tests
Respiratory mechanics
