根据校正体重测算肥胖患者全身麻醉机械通气潮气量的可行性
发布时间：2018-11-13 06:35
【摘要】：目的： 麻醉手术过程中,需要为患者设置一个合理的潮气量,传统上是按照8ml/kg实际体重计算潮气量,呼吸频率为15次/min。但是随着生活水平的提高,人们体重超重和肥胖的发生率也在逐步升高。如果我们根据目前的测算潮气量方法设置潮气量,那么这样的潮气量对于体重超标的人群是否合适?在临床工作中我们发现肥胖患者采用该潮气量机械通气时存在不同程度的过度通气。有学者提出用理想体重来计算潮气量,在临床应用中发现其对于肥胖患者偏差也较大。因此,我们根据预实验结果提出以理想体重加超标体重的30%做为校正体重,同时尝试根据理想体重、校正体重和实际体重来测算潮气量,对比其氧合及二氧化碳排出情况,并检测是否有呼吸机相关的肺损伤,以探讨适合肥胖患者的潮气量测算方法。方法： 择期行四肢手术的肥胖患者60例,均为平卧位手术,ASA Ⅰ～Ⅱ级,随机分成3组,每组20例,分别按8ml/kg理想体重(IBW组)、校正体重(CBW组)和实际体重(ABW组)设置初始潮气量,呼吸频率为15次/min。校正体重为理想体重加超标体重的30%,理想体重计算公式应用的是我国常用的Broca改良式：男性为理想体重(kg)=身高(cm)-105；女性为理想体重(kg)=身高(cm)-105-2.5。机械通气开始后10min观察记录气道峰压(Ppeak)、气道平台压(Pplat)和气道阻力(Raw)；于机械通气后30min抽动脉血测血气分析,记录动脉血二氧化碳分压(PaCO2),并对PaCO245mmHg或35mmHg的患者重新调整潮气量,记录各组需要调整潮气量的患者例数,记录动脉血氧分压(Pa02)并计算氧合指数(OI)；于机械通气后1h抽动脉血3ml,ELISA法测定血清中IL-6和IL-8浓度。 结果： 按照三种不同方法计算潮气量进行机械通气后Pa02和OI无明显差异(P0.05),均能提供很好的氧合。与CBW组相比,IBW组PaCO2明显升高(P0.01), ABW组PaCO2明显降低(P＜0.01);IBW组和ABW组需要调整呼吸参数的患者例数(16/20和19/20)与CBW组(0/20)相比明显增加(P0.01)；与CBW组相比,ABW组Ppeak、Pplat、Raw明显升高(P0.01)；与CBW组相比,ABW组IL-6和IL-8浓度明显升高(P0.01)。 结论： 对于肺功能正常的肥胖患者,将呼吸频率设为15次/min时,按校正体重(理想体重加超标体重的30%)以8ml/kg设置初始潮气量较为合适,能维持良好的氧合和二氧化碳的排出,减少机械通气引起的肺损伤,降低再次调整呼吸参数的比例。
[Abstract]:Objective: during anaesthesia operation, it is necessary to set up a reasonable tidal volume for the patient. Traditionally, the tidal volume is calculated according to the actual weight of 8ml/kg, and the respiratory frequency is 15 times / min.. But with rising living standards, the incidence of overweight and obesity is increasing. If we set up a tidal volume based on the current method of measuring moisture, is it appropriate for people who are overweight? In clinical work, we found that obese patients had different degrees of hyperventilation when using the tidal volume mechanical ventilation. Some scholars have suggested that the ideal weight should be used to calculate the moisture volume, and it is found that there is also a large deviation for obese patients in clinical application. Therefore, based on the results of the pre-experiment, we propose to take the ideal weight plus 30% of the excess body weight as the corrected weight, and at the same time we try to calculate the moisture volume according to the ideal weight, the corrected weight and the actual weight, and compare the oxygen and carbon dioxide emissions. To investigate the method of measuring tidal volume for obese patients, and to detect ventilator-related lung injury. Methods: sixty patients with obesity underwent elective limb surgery were divided into 3 groups randomly, 20 cases in each group according to the ideal weight of 8ml/kg (IBW group). All patients were operated on in supine position. The patients were divided into 3 groups (ASA 鈪，
本文编号：2328289
[Abstract]:Objective: during anaesthesia operation, it is necessary to set up a reasonable tidal volume for the patient. Traditionally, the tidal volume is calculated according to the actual weight of 8ml/kg, and the respiratory frequency is 15 times / min.. But with rising living standards, the incidence of overweight and obesity is increasing. If we set up a tidal volume based on the current method of measuring moisture, is it appropriate for people who are overweight? In clinical work, we found that obese patients had different degrees of hyperventilation when using the tidal volume mechanical ventilation. Some scholars have suggested that the ideal weight should be used to calculate the moisture volume, and it is found that there is also a large deviation for obese patients in clinical application. Therefore, based on the results of the pre-experiment, we propose to take the ideal weight plus 30% of the excess body weight as the corrected weight, and at the same time we try to calculate the moisture volume according to the ideal weight, the corrected weight and the actual weight, and compare the oxygen and carbon dioxide emissions. To investigate the method of measuring tidal volume for obese patients, and to detect ventilator-related lung injury. Methods: sixty patients with obesity underwent elective limb surgery were divided into 3 groups randomly, 20 cases in each group according to the ideal weight of 8ml/kg (IBW group). All patients were operated on in supine position. The patients were divided into 3 groups (ASA 鈪，
本文编号：2328289
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