潮气量对脉搏氧指容积波波幅变异度的影响

发布时间：2018-10-12 09:14

【摘要】：目的探讨潮气量(tidal volume, Vt)对脉搏氧指容积波波幅变异度(respiratoryvariation in pulse oximetry plethysmographic waveform amplitude, dPOP)的影响。方法选择全身麻醉的手术患者50例，采取自身对照原则，每位患者给予相同的麻醉方法及干预措施。开放静脉以10mL·kg-1·h-1的速率输注乳酸林格氏液，快诱导气管插管后，设定初始Vt=8mL/kg、I:E=1:2、f=12次/分、PEEP=0。以1%异氟醚复合2～8ng/L靶浓度的瑞芬太尼维持麻醉，调整麻醉药浓度使CSI值在40～60之间。机械通气3min后，根据随机数字表确定先后给予Vt为6mL/kg、9mL/kg、12mL/kg机械通气的顺序，，每一干预Vt分别维持3min，并记录干预前后的血流动力学参数及呼吸动力学参数。光电监护仪同时记录脉搏氧指容积波(pulse oximetry plethysmograph, POP)及呼气末二氧化碳曲线，NICOM监护仪监测HR、SBP、DBP、MAP、心脏指数(cardiac Index, CI)、每搏量指数(stroke volume index, SVI)、每搏量变异度(stroke volume variation, SVV)等参数。根据公式计算dPOP。结果剔除病历11例，纳入研究39例。Vt为12mL/kg与6mL/kg机械通气后比较：CI、SVI降低，SVV、dPOP、气道峰压(peak airway pressure, Ppeak)、气道平台压(plat airway pressuer, Pplat)升高，两组间比较差异有统计学意义(P＜0.05)。Vt为9mL/kg与6mL/kg机械通气后比较，Vt为12mL/kg与9mL/kg机械通气后比较：SVV、dPOP、Ppeak、Pplat均升高，组间比较差异有统计学意义(P＜0.05)。Vt为6mL/kg、9mL/kg、12mL/kg机械通气后，dPOP与SVV有良好线性相关(P＜0.05)，相关系数分别为0.684、0.817、0.699。dPOP与3个干预Vt有显著线性相关(P＜0.05)，相关系数分别为0.428、0.638、0.543。结论Vt可以影响dPOP的准确性。
[Abstract]:Objective to investigate the effect of tidal volume (tidal volume, Vt) on pulse oxygen finger volume wave amplitude variability (respiratoryvariation in pulse oximetry plethysmographic waveform amplitude, dPOP). Methods A total of 50 patients undergoing general anesthesia were treated with the principle of self-control. Each patient was given the same anesthetic method and intervention. Open vein was infused with Ringer lactate solution at the rate of 10mL kg-1 h-1. After induction of tracheal intubation, initial Vt=8mL/kg,I:E=1:2,f=12 times / min, PEEP=0. were set. Remifentanil with 1% isoflurane and 2~8ng/L target concentration was used to maintain anesthesia and adjust the concentration of anesthetic to make the CSI value between 40 and 60. After mechanical ventilation (3min), the sequence of mechanical ventilation with Vt of 6 mL / kg / kg or 9 mL / kg or 12 mL / kg was determined according to random number table. Each intervention Vt was maintained for 3 minutes, and the hemodynamic parameters and respiratory parameters before and after intervention were recorded. The pulse oxygen finger volume wave (pulse oximetry plethysmograph, POP) and end-expiratory carbon dioxide (end-expiratory carbon dioxide) curves were recorded by the photoelectric monitor. The HR,SBP,DBP,MAP, cardiac index (cardiac Index, CI), the volume index (stroke volume index, SVI), the variability per stroke (stroke volume variation, SVV), and so on were monitored by the NICOM monitor. Calculating dPOP. according to formula Results 11 cases were excluded and 39 cases were included in the study. Vt was compared with that of 6mL/kg after mechanical ventilation: CI,SVI decreased, and (peak airway pressure, Ppeak), airway plateau pressure of SVV,dPOP, increased. There was a significant difference between the two groups (P < 0. 05) (P < 0. 05). There was a significant difference between the two groups (P < 0. 05) after 9mL/kg and 6mL/kg mechanical ventilation, and Vt was compared with 12mL/kg and 9mL/kg after mechanical ventilation. There was a significant linear correlation between dPOP and SVV after mechanical ventilation (P < 0. 05). The correlation coefficients were 0. 684 ~ 0. 817 ~ 0. 699. 9 d pop and 3 intervention Vt (P < 0. 05). The correlation coefficients were 0. 428, 0. 638 and 0. 543 respectively. Conclusion Vt can affect the accuracy of dPOP.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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