喉罩和气管插管在新生儿腹部手术时应用不同通气模式通气有效性的对比研究
发布时间：2018-10-15 09:25
【摘要】：研究背景：新生儿气道不同于成人，由于其解剖结构与气道阻力构成均与成人不同，胸廓短，气管血管丰富，软骨柔软，支撑作用弱，，气道纤毛运动差，易于出血，感染和呼吸道梗阻。同时新生儿也是生理变化最大的时候，对于缺氧敏感度较高。气道压过高的正压通气,可以作用于血管壁和肺泡,气体进入间质组织,沿支气管肺泡进入纵膈而产生气压伤,以及吸气末肺高容量可造成肺扩张过度,导致损伤肺泡,增加毛细血管通透性,从而造成肺水肿，称机械通气致肺损伤(ventilator induced lung injury, VILI)。对比新生儿在全麻下使用喉罩和气管插管时在不同通气模式下气道峰压（PIP）与潮气量（TV）的关系以及不同呼吸频率的影响，目前相关报道不多见。 目的：对比新生儿在全麻下行腹部手术时使用喉罩和气管插管时在压力控制通气（PCV）模式和容量控制通气（VCV）下气道峰压（PIP）与潮气量（TV）的关系以及不同呼吸频率对呼末二氧化碳（PETCO_2）的影响。方法：行腹部手术的新生儿（出生24小时至28天）患者80例，出生时Apgar评分大于7分，体重大于2.5kg。吸入七氟醚麻醉后进行气管插管或置入喉罩，患儿按照随机顺序接受气管插管或喉罩通气，通气期间给予监测呼末二氧化碳及心电图、血压、血氧饱和度等生命指证监测。每位患儿按随机顺序接受气管插管和喉罩两种人工气道进行通气和不同的通气模式通气，呼吸频率35次/分和40次/分,吸呼比1:2,呼气末正压通气(PEEP)设置为5cmH_2O。呼吸机设定的吸气压力为分别14cmH_2O、16cmH_2O、18cmH_2O和20cmH_2O。设定吸气压力时,同时测定PETCO_2波动的范围。通气至少稳定15min后记录潮气量、PETCO_2、HR、BP等呼吸和循环参数。所有参数测量3次后取均数表示。 结果：（1）在压力模式通气下气道峰压分别在14～18cmH_2O时，喉罩组和气管插管组潮气量和呼末二氧化碳值差异无统计学差异（P＞0.05）。气道峰压在20cmH_2O时，喉罩组和气管插管组潮气量差异有统计学意义（P＜0.05）。不同呼吸频率下的呼末二氧化碳值没有明显差异(p0.05)（2）容量模式下，插管组和喉罩组在相同气道峰压时潮气量没有明显差异(p0.05)，呼末二氧化碳值也没有明显差异(p0.05)。（3）在喉罩组中压力模式和容量模式在气道峰压值分别在14～20cmH_2O时，潮气量和呼末二氧化碳值的差异无统计学意义（P＞0.05） 结论：新生儿在全麻期间，喉罩与气管插管在压力通气通气模式下气道峰压为14～18cmH_2O均能安全等效的提供患儿所需的潮气量并保证呼末二氧化碳的正常范围。使用压力控制模式通气情况下压力值在14～20cmH_2O时，气管插管组和喉罩组相比通气的潮气量增加明显。
[Abstract]:Background: neonatal airway is different from adults because of its different anatomical structure and airway resistance structure, short chest, abundant tracheal vessels, soft cartilage, weak support, poor airway cilia movement and easy bleeding. Infection and obstruction of respiratory tract. At the same time, the newborn is also the most physiological changes, high sensitivity to hypoxia. Positive airway pressure ventilation acts on the walls of blood vessels and alveoli, the gas enters the interstitial tissue, the air enters the mediastinum along the bronchoalveoli, and the high volume of the lungs at the end of inspiration can cause excessive pulmonary dilatation, leading to the injury of the alveoli. Increase capillary permeability, resulting in pulmonary edema, known as mechanical ventilation to cause lung injury (ventilator induced lung injury, VILI). To compare the relationship between peak airway pressure (PIP) and tidal volume (TV) during laryngeal mask and tracheal intubation in neonates under general anesthesia and the effects of different respiratory frequencies, there are few reports about the relationship between peak airway pressure (PIP) and tidal volume (TV) in different ventilation modes. Objective: to compare the relationship between peak airway pressure (PIP) and tidal volume (TV) under pressure controlled ventilation (PCV) and volume controlled ventilation (VCV) during laryngeal mask and tracheal intubation during abdominal surgery under general anesthesia. The effect of carbon dioxide (PETCO_2). Methods: 80 newborns (24 hours to 28 days old) underwent abdominal surgery. The Apgar score at birth was more than 7 and the weight was more than 2.5 kg. After inhaling sevoflurane anesthesia, tracheal intubation or laryngeal mask placement was performed, and the children were given tracheal intubation or laryngeal mask ventilation in random order. During ventilation, life indicators such as end-exhalation carbon dioxide, electrocardiogram, blood pressure and oxygen saturation were monitored. Each child was given tracheal intubation and larynx mask for ventilation and different ventilation modes in random order. The respiratory frequency was 35 / min and 40 / min, the breathing ratio was 1: 2, and the positive end-expiratory pressure (PEEP) was set to 5 cm H _ 2O. The inspiratory pressure set by ventilator is 14cmH _ 2O / 16cm H _ 2O _ 2O _ (18 cm H _ 2O) and 20cm H _ 2O _ 2 respectively. When the inspiratory pressure is set, the range of PETCO_2 fluctuations is also measured. Tidal volume, PETCO_2,HR,BP and other respiratory and circulatory parameters were recorded after ventilation at least after 15min. All parameters are measured 3 times and then the mean is expressed. Results: (1) there was no significant difference in tidal volume and end-exhalation carbon dioxide between laryngeal mask group and tracheal intubation group when peak airway pressure was in 14~18cmH_2O (P > 0. 05). There was significant difference in tidal volume between laryngeal mask group and tracheal intubation group when peak airway pressure was in 20cmH_2O (P < 0. 05). There was no significant difference in end-respiratory carbon dioxide values at different respiratory frequencies (p0.05) (2) volume mode. There was no significant difference in tidal volume between intubation group and laryngeal mask group at the same peak airway pressure (p0.05), and there was no significant difference in end-respiratory carbon dioxide value (p0.05). (3) in the laryngeal mask group when the peak airway pressure and volume mode were at 14~20cmH_2O, respectively. There was no significant difference in tidal volume and end-exhalation carbon dioxide (P > 0.05). Conclusion: during general anesthesia, there was no significant difference in tidal volume and carbon dioxide value (P > 0.05). Both laryngeal mask and endotracheal intubation can safely and effectively provide the required tidal volume and ensure the normal range of end-exhalation carbon dioxide when the peak airway pressure is 14~18cmH_2O in the pressure ventilation mode. The tidal volume of tracheal intubation group and laryngeal mask group increased significantly when the pressure value of 14~20cmH_2O was used in pressure control mode.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.1
本文编号：2272091
[Abstract]:Background: neonatal airway is different from adults because of its different anatomical structure and airway resistance structure, short chest, abundant tracheal vessels, soft cartilage, weak support, poor airway cilia movement and easy bleeding. Infection and obstruction of respiratory tract. At the same time, the newborn is also the most physiological changes, high sensitivity to hypoxia. Positive airway pressure ventilation acts on the walls of blood vessels and alveoli, the gas enters the interstitial tissue, the air enters the mediastinum along the bronchoalveoli, and the high volume of the lungs at the end of inspiration can cause excessive pulmonary dilatation, leading to the injury of the alveoli. Increase capillary permeability, resulting in pulmonary edema, known as mechanical ventilation to cause lung injury (ventilator induced lung injury, VILI). To compare the relationship between peak airway pressure (PIP) and tidal volume (TV) during laryngeal mask and tracheal intubation in neonates under general anesthesia and the effects of different respiratory frequencies, there are few reports about the relationship between peak airway pressure (PIP) and tidal volume (TV) in different ventilation modes. Objective: to compare the relationship between peak airway pressure (PIP) and tidal volume (TV) under pressure controlled ventilation (PCV) and volume controlled ventilation (VCV) during laryngeal mask and tracheal intubation during abdominal surgery under general anesthesia. The effect of carbon dioxide (PETCO_2). Methods: 80 newborns (24 hours to 28 days old) underwent abdominal surgery. The Apgar score at birth was more than 7 and the weight was more than 2.5 kg. After inhaling sevoflurane anesthesia, tracheal intubation or laryngeal mask placement was performed, and the children were given tracheal intubation or laryngeal mask ventilation in random order. During ventilation, life indicators such as end-exhalation carbon dioxide, electrocardiogram, blood pressure and oxygen saturation were monitored. Each child was given tracheal intubation and larynx mask for ventilation and different ventilation modes in random order. The respiratory frequency was 35 / min and 40 / min, the breathing ratio was 1: 2, and the positive end-expiratory pressure (PEEP) was set to 5 cm H _ 2O. The inspiratory pressure set by ventilator is 14cmH _ 2O / 16cm H _ 2O _ 2O _ (18 cm H _ 2O) and 20cm H _ 2O _ 2 respectively. When the inspiratory pressure is set, the range of PETCO_2 fluctuations is also measured. Tidal volume, PETCO_2,HR,BP and other respiratory and circulatory parameters were recorded after ventilation at least after 15min. All parameters are measured 3 times and then the mean is expressed. Results: (1) there was no significant difference in tidal volume and end-exhalation carbon dioxide between laryngeal mask group and tracheal intubation group when peak airway pressure was in 14~18cmH_2O (P > 0. 05). There was significant difference in tidal volume between laryngeal mask group and tracheal intubation group when peak airway pressure was in 20cmH_2O (P < 0. 05). There was no significant difference in end-respiratory carbon dioxide values at different respiratory frequencies (p0.05) (2) volume mode. There was no significant difference in tidal volume between intubation group and laryngeal mask group at the same peak airway pressure (p0.05), and there was no significant difference in end-respiratory carbon dioxide value (p0.05). (3) in the laryngeal mask group when the peak airway pressure and volume mode were at 14~20cmH_2O, respectively. There was no significant difference in tidal volume and end-exhalation carbon dioxide (P > 0.05). Conclusion: during general anesthesia, there was no significant difference in tidal volume and carbon dioxide value (P > 0.05). Both laryngeal mask and endotracheal intubation can safely and effectively provide the required tidal volume and ensure the normal range of end-exhalation carbon dioxide when the peak airway pressure is 14~18cmH_2O in the pressure ventilation mode. The tidal volume of tracheal intubation group and laryngeal mask group increased significantly when the pressure value of 14~20cmH_2O was used in pressure control mode.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.1
【参考文献】
相关期刊论文 前2条
1 施丽萍,孙眉月,杜立中;新生儿呼吸窘迫综合征呼吸机治疗的肺保护性研究[J];中华儿科杂志;2003年02期
2 赵熙,李成辉,贾乃光;喉罩在临床上的应用[J];中华麻醉学杂志;2001年08期
本文编号：2272091
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