小潮气量机械通气对全麻手术患者肺换气功能的影响

发布时间：2018-01-24 21:04

本文关键词： 小潮气量机械通气肺换气动静脉氧分压差肺泡-动脉氧分压差肺内分流率　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过采集全麻手术患者在小潮气量机械通气和常用潮气量通气下的动静脉血气检测数据,计算动静脉氧分压差、肺泡动脉氧分压差和肺内分流率等,观察小潮气量机械通气对全麻手术患者肺换气功能的影响,探索有利于全麻手术患者的潮气量。方法按照设定的纳入和排除标准,选取2015年3月至2016年9月在解放军306医院行择期手术的患者80例,其中仰卧位手术42例,俯卧位手术38例,ASA分级均是Ⅰ或Ⅱ级,将全部试验对象的80例患者记为Total Subject,仰卧位记为Supine Group,俯卧位记为Prone Group。所有的患者均采用全凭静脉全身麻醉,麻醉诱导完成后,设置机械通气参数为容量控制模式,吸入氧流量为2L/min,设置潮气量(VT)为8 ml/kg(不同的组别分别为T8,S8和P8组),呼吸频率为10次/分,30min后行动脉血气分析,同时将VT设置为6 ml/kg(不同的组别分别为T6,S6和P6组),呼吸频率为13次/分,30min后再次行动脉血气分析。收集记录研究过程中生命体征及血气分析监测数据,计算动静脉氧分压差(Pa-v O2)、肺泡动脉氧分压(PA-aO2)及肺内分流率(QS/QT)。对收集的资料应用SPSS 19.0医学统计软件包进行统计分析论证。符合正态分布的计量资料,采用均数±标准差(MEAN±SD)表示;多组间(≥2组)均数的比较,采用单因素重复测量方差分析进行检验。所采用的全部检验方法,均定义P0.05为差异有统计学意义。结果在全麻手术中给予机械通气的情况下:(1)不考虑体位的影响时,VT为8ml/kg时,Pa-v O2为(402.10±103.55mm Hg),VT为6ml/kg时,Pa-v O2为(419.70±73.13mm Hg),P=0.2220.05,即不分体位时,T8与T6对Pa-v O2的影响无明显差别。潮气量为8ml/kg时的PA-a O2为(206.3±100.01mm Hg),潮气量6ml/kg时PA-a O2为(177.45±175.62mm Hg),P=0.0690.05,即不分体位时,T8与T6对PA-a O2的影响无明显差别。潮气量为8ml/kg时QS/QT为(11.10±4.66%),潮气量6ml/kg时QS/QT为(9.76±3.83%),P=0.0620.05,即T8与T6对QS/QT的影响无明显差别。(2)仰卧位时,VT为8ml/kg时,Pa-v O2为(388.85±95.16mm Hg),VT为6ml/kg时,Pa-v O2为(404.00±74.52mm Hg),P=0.2690.05,即仰卧位时,S8与S6对Pa-v O2的影响无明显差别。仰卧位时,潮气量为8ml/kg时的PA-a O2为(221.27±92.73mm Hg),潮气量6ml/kg时PA-a O2为(199.17±92.73mm Hg),P=0.1670.05,即仰卧位时,S8与S6对PA-a O2的影响无明显差别。潮气量为8ml/kg时QS/QT为(11.86±4.28%),潮气量6ml/kg时QS/QT为(10.87±3.43%),P=0.1610.05,即S8与S6对QS/QT的影响无明显差别(3)俯卧位时,VT为8ml/kg时,Pa-v O2为(426.71±121.48mm Hg),VT为6ml/kg时,Pa-v O2为(448.86±65.62mm Hg),P=0.320.05,即俯卧位时,P8与P6对Pa-v O2的影响无明显差别。俯卧位时,潮气量为8ml/kg时的PA-a O2为(178.85±114.39mm Hg),潮气量6ml/kg时PA-a O2为(137.11±74.20mm Hg),P=0.2680.05,即俯卧位时,P8与P6对PA-a O2的影响无明显差别。潮气量为8ml/kg时QS/QT为(9.67±5.33%),潮气量6ml/kg时QS/QT为(7.69±3.92%),P=0.2480.05,即P8与P6对QS/QT的影响无明显差别。(4)VT为8ml/kg时,仰卧位时的Pa-v O2为(388.85±95.16mm Hg),俯卧位时的Pa-v O2为(426.71±121.48mm Hg),P=0.4500.05,即潮气量为8ml/kg时,仰卧位对Pa-v O2的影响较俯卧位时无明显差别;潮气量为8ml/kg时,仰卧位时的PA-a O2为(221.27±92.73mm Hg),俯卧位时的PA-a O2为(178.85±114.39mm Hg),P=0.4140.05,即潮气量为8ml/kg时,仰卧位对PA-a DO2的影响较俯卧位无明显差别;潮气量为8ml/kg时,仰卧位QS/QT为(11.86±4.28%),俯卧位时的QS/QT为(9.67±5.33%),P=0.3290.05,即潮气量为8ml/kg时,仰卧位对QS/QT的影响较俯卧位无明显差别。(5)VT为6ml/kg时,仰卧位时的Pa-v O2为(404.00±74.52mm Hg),俯卧位时的Pa-v O2为(448.86±65.62mm Hg),P=0.1990.05即潮气量为6ml/kg时,仰卧位对Pa-v O2的影响较俯卧位时无明显差别;潮气量为6ml/kg时,仰卧位时的PA-a O2为(199.17±92.73mm Hg),俯卧位时的PA-a O2为(137.11±74.20mm Hg),P=0.0790.05,即潮气量为6ml/kg时,仰卧位对PA-a O2的影响较俯卧位无明显差别;潮气量为6ml/kg时,仰卧位QS/QT为(10.87±3.43%),俯卧位时的QS/QT为(7.69±3.92%),P=0.0750.05,即潮气量为6ml/kg时,仰卧位对QS/QT的影响较俯卧位无明显差别。结论从肺换气功能的角度来考虑,不论患者是仰卧位还是俯卧位,小潮气量与常用潮气量对肺换气功能的影响都没有明显区别,即小潮气量机械通气可以安全地应用于全麻手术患者。
[Abstract]:Objective To study the effects of small tidal volume mechanical ventilation on pulmonary ventilation in patients with general anesthesia by measuring the effects of small tidal volume mechanical ventilation on pulmonary ventilation function in patients with general anesthesia . When tidal volume was 8ml / kg , PA - a O2 was ( 206.3 卤 100.01mm Hg ) , tidal volume 6ml / kg PA - a O2 was ( 177.45 卤 175.62mm Hg ) , P = 0.060.05 , i.e . , when the tidal volume was 8ml / kg , QS / QT was ( 11.10 卤 4.66 % ) , tidal volume 6ml / kg , QS / QT was ( 9.76 卤 3.83 % ) , P = 0.0620 . 05 , that is , T8 and T6 had no significant difference on QS / QT . When the tidal volume was 8 ml / kg , the PA - a O2 at 8 ml / kg was ( 11.86 卤 92.73 mm Hg ) , P = 0.1670.05 , that is , the PA - a O2 at 8 ml / kg was ( 174.86 卤 12.73 mm Hg ) , P = 0.1670.05 , that is , the PA - a O2 was ( 137.11 卤 74.20 mm Hg ) at 6 ml / kg , P = 0.2680.05 , that is , when lying prone position , When the tidal volume was 8ml / kg , the supine position had no significant difference between the supine position and the supine position when the tidal volume was 8ml / kg . When the tidal volume was 6 ml / kg , the supine position was ( 10.87 卤 3.92 % ) , P = 0.070.05 , that is , when the tidal volume was 6 ml / kg , the supine position had no significant difference in the influence of the supine position on the pulmonary ventilation function .

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614.2

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