低流量定量麻醉的可行性研究

发布时间：2018-11-14 15:32

【摘要】：目的将低流量吸入麻醉技术与定量麻醉的计算方法和呼吸环路内给药方法相结合，观察和分析该吸入麻醉给药方法的可行性和准确性。方法本研究采用前瞻性、随机、对照、单盲试验的设计方法，将符合本试验标准的30例患者纳入研究。根据载气量的不同，将研究对象随机均分两组，载气量1000ml/min为A组（n=15）、载气量800ml/min为B组(n=15)。静脉麻醉诱导气管插管后静吸复合维持麻醉，瑞芬太尼2-6ng/ml靶控输注，，将液态挥发性麻醉药异氟烷在呼吸环路的呼气端输注至呼吸回路内。异氟烷的输注量由两部分组成，第一部分根据定量麻醉的计算方法，计算出维持异氟烷0.8最低肺泡有效浓度（MAC）所需的预充量和单位量，第二部分是超出机体氧耗量的载气所需药量，两部分输注药量均按维持0.8最低肺泡有效浓度（minimumalveolar concentration,MAC）计算。每5min记录两组呼吸环路内吸入气麻醉药浓度（Fi）、呼出气麻醉药的浓度（Fe）、MAC、吸入氧浓度(FiO2)、呼气末二氧化碳（PETCO2）。应用偏离性（MDPE）、精确度（MDAPE）和摆动度(WOBBLE)评价两组给药系统的准确性。结果两组患者一般情况比较差异无统计学意义(P＞0.05)。术中两组间FiO2、PETCO2比较差异有统计学意义(P＜0.05)，A组FiO2平均值大于B组，A组PETCO2平均值小于B组。两组间异氟烷呼气末浓度Fe、MAC、MDPE、MDAPE、摆动度的比较差异无统计学意义(P＞0.05)。将两组MAC与标准值0.8相比较，差异无统计学意义(P＞0.05)，两组MDPE与标准值0相比较，差异无统计学意义(P＞0.05)。A组10%～90%MDPE、MDAPE的累计频率分布范围分别为-12.5%～8.75%、0%～12.5%，B组分别为-12.5%~12.5%和0%～12.5%，均在临床可接受范围。两组间异氟烷Fi的比较差异有统计学意义(P＜0.05), A组大于B组。结论采用定量麻醉的计算方法，将呼吸环路内变速输注液态挥发性吸入麻醉药的方法与低流量吸入麻醉技术相结合，可以使环路内吸入麻醉药物浓度快速上升，并能维持呼吸环路内吸入麻醉药物浓度在设定值水平。编制的定量麻醉计算程序的准确性得到了验证。
[Abstract]:Objective to observe and analyze the feasibility and accuracy of low flow inhalation anesthesia, quantitative anesthesia and respiratory loop administration. Methods A prospective, randomized, controlled, single blind trial was used to study 30 patients who met the criteria of this study. According to the difference of carrier gas volume, the subjects were randomly divided into two groups: group A (1000ml/min) and group B (800ml/min). After induction of endotracheal intubation by intravenous anesthesia, intravenous inhalation combined with maintenance anesthesia, remifentanil 2-6ng/ml target controlled infusion, the liquid volatile anesthetic isoflurane was injected into the respiratory loop at the end of the breath loop. The infusion of isoflurane consists of two parts. In the first part, the precharge and unit amount required to maintain the minimum alveolar effective concentration (MAC) of isoflurane 0.8 are calculated according to the calculation method of quantitative anesthesia. The second part is about the amount of gas needed in excess of the amount of oxygen consumed by the body. Both of the two parts are calculated according to the maintenance of the minimum alveolar effective concentration (minimumalveolar concentration,MAC) of 0. 8. Each 5min recorded the concentration of inhaled anesthetics in two groups in the respiratory loop. The concentration of (Fe), MAC, inhaled oxygen (FiO2) and end-expiratory carbon dioxide (PETCO2) were recorded in (Fi), exhaled anesthetic. Deviation (MDPE), accuracy (MDAPE) and swing degree (WOBBLE) were used to evaluate the accuracy of two groups of drug delivery systems. Results there was no significant difference in general condition between the two groups (P > 0.05). There was significant difference in FiO2,PETCO2 between the two groups during operation (P < 0. 05). The average value of FiO2 in group A was higher than that in group B (P < 0. 05), and the average value of PETCO2 in group A was lower than that in group B. There was no significant difference in Fe,MAC,MDPE,MDAPE, swing between the two groups (P > 0. 05). There was no significant difference in MAC between the two groups (P > 0. 05), but there was no significant difference in MDPE between the two groups compared with the standard value 0 (P > 0. 05). A). The accumulative frequency distribution range of MDAPE was -12.5% and -12.75%, respectively, and 12.5% and 12.5% in group B, respectively, which were both in the range of clinical acceptability. The difference of isoflurane Fi between the two groups was statistically significant (P < 0. 05). Conclusion the method of quantitative anaesthesia and the combination of variable velocity infusion of liquid volatile inhaled anesthetic in respiratory loop and low flow inhalation anesthesia technology can make the concentration of inhaled anesthetic in the loop rise rapidly. The concentration of inhaled anesthetic in respiratory loop can be maintained at the set level. The accuracy of the program was verified.
【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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