甲基强的松龙对全身麻醉老年患者术中呼吸力学参数的影响及其临床意义

发布时间：2018-02-24 20:42

本文关键词： 甲基强的松龙呼吸力学全身麻醉老年人　出处：《吉林大学学报(医学版)》2017年02期 　论文类型：期刊论文

【摘要】：目的:研究甲基强的松龙(甲强龙)对全身麻醉插管行机械通气后老年患者呼吸力学参数的影响,探讨甲强龙是否可以改善老年患者呼吸系统退行性病变以及有利于机械通气。方法:将60例择期行开腹手术的老年患者按其意愿分为实验组和对照组(n=30)。气管插管后实验组患者静脉注射甲强龙1mL(40mg),对照组患者静脉注射生理盐水1 mL。于给药前即刻和给药后10、20、30及40 min时记录2组患者气道峰压(Ppeak)、气道平台压(Pplat)、肺的顺应性(Compl)和气道阻力(Raw),在给药前即刻和给药后20min时记录动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)和呼气末二氧化碳分压(PetCO_2)。结果:与给药前即刻比较,对照组患者给生理盐水后10、20、30和40 min时各呼吸力学参数比较差异无统计学意义(P0.05);实验组患者在给药后10、20、30和40min时Compl明显升高(P0.05),Ppeak、Pplat和Raw明显降低(P0.05)。与对照组比较,实验组患者在给药后10、20、30和40 min时Compl明显升高(P0.05),Ppeak、Pplat和Raw明显降低(P0.05)。与给药前即刻比较,对照组患者给药后20min时PaO_2、PaCO_2和PetCO_2差异无统计学意义(P0.05);实验组患者给药后20min时PaCO_2和PetCO_2降低(P0.05),PaO_2升高(P0.05)。与对照组比较,实验组患者给药20 min时PaCO_2和PetCO_2降低(P0.05),PaO_2升高(P0.05)。结论:甲强龙可明显降低老年患者PaCO_2、Ppeak、Pplat和Raw,增加PaO_2和Compl;甲强龙能够改善老年患者呼吸系统退行性病变给全身麻醉带来的不利影响。
[Abstract]:Objective: to study the effect of methylprednisolone on respiratory mechanical parameters of elderly patients undergoing mechanical ventilation under general anesthesia intubation. To investigate whether methylprednisolone can improve the degenerative diseases of the respiratory system in elderly patients and to facilitate mechanical ventilation. Methods: 60 elderly patients undergoing elective laparotomy were divided into experimental group and control group according to their wishes. Tracheal intubation was performed. The patients in the experimental group were injected intravenously with 1 mL of methylenolone and those in the control group were injected with 1 mL of normal saline. Peak airway pressure (Ppeaka), airway plateau pressure (Pplata), pulmonary compliance (complicity) and airway were recorded in both groups immediately before administration and 10 ~ 20 ~ 30 and 40 min after administration. Resistance, immediately before administration and 20 minutes after administration, the arterial partial pressure of oxygen (Pao _ 2), the partial pressure of arterial blood carbon dioxide (Paco _ 2), and the partial pressure of end-expiratory carbon dioxide (PECO _ 2C _ 2) were recorded. Results: compared with the immediate before administration, the arterial oxygen partial pressure (Pao _ 2) and the arterial blood carbon dioxide partial pressure (Paco _ 2) were recorded. There was no significant difference in the respiratory mechanical parameters between the control group and the control group at 30 and 40 minutes after the administration of normal saline, while the Compl of the patients in the experimental group increased significantly at 30 and 40 minutes after the administration of normal saline, and the levels of P0.05Pplat and Raw in the control group were significantly lower than those in the control group. In the experimental group, the levels of Compl increased significantly at 30 and 40 min after administration of P0.05, Ppeak-Pplat and Raw were significantly decreased compared with those immediately before administration. In the control group, there was no significant difference in Paco _ 2 and PetCO_2 20 minutes after administration of Paco _ 2, but in the experimental group, PaCO_2 and PetCO_2 decreased P0.05P0.05 compared with the control group. In the experimental group, PaCO_2 and PetCO_2 decreased P0.05 and PaO-2 increased at 20 min. Conclusion: mestrone can significantly reduce Paco _ 2 Ppeak-Pplat and Rawl, increase PaO_2 and complicity, and improve the adverse effects of degenerative diseases of respiratory system on general anesthesia in elderly patients.
【作者单位】：吉林大学第二医院麻醉科;
【基金】：吉林省科技厅科技发展计划项目资助课题(2016101087JC)
【分类号】：R614.2

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