| 肺保护性通气策略用于大容量肺灌洗麻醉的术中评价 |
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| 引用本文： | 李文静,胡振宇,沈有舟,刘晓梅.肺保护性通气策略用于大容量肺灌洗麻醉的术中评价[J].职业卫生与应急救援,2017,35(6):507-509. |
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| 作者姓名： | 李文静 胡振宇 沈有舟 刘晓梅 |
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| 作者单位： | 深圳市职业病防治院, 广东 深圳 518020 |
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| 基金项目： | 深圳市2015科技计划创新项目JCYJ20150403091305483 |
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| 摘 要： | 目的 观察肺保护性通气策略在大容量肺灌洗麻醉中的效果, 了解其对术中生命体征的影响, 为单肺通气手术的麻醉提供参考。 方法 选取职业性尘肺病患者60例, 随机分为定容通气组(对照组)和保护性通气组(试验组), 采用顺序诱导, 支气管内插管, 全身麻醉。术中全凭静脉全身麻醉维持。通气肺行单肺通气, 对照组术中采取传统通气法:潮气量8~10 mL/kg, 呼吸12~14/min, 吸入气中氧体积分数=1.0, 气道压2.5~4 kPa, 动脉血二氧化碳分压30~45 mmHg; 试验组则实施肺保护性通气策略:潮气量6~8 mL/kg, 呼吸14~16/min, 吸入气中氧体积分数=1.0, 气道压1.5~2.5 kPa, 动脉血二氧化碳分压40~55 mmHg, 呼气末正压通气0.8~1.0 kPa。比较两组患者麻醉前5 min、灌洗开始后10 min、拔管后10 min各个时间点的平均动脉压、心率、脉搏氧饱和度及呼气末二氧化碳分压值。 结果 试验组动脉压均值在术中和术毕都高于对照组, 试验组术毕心率均值高于对照组, 差异均有统计学意义(P < 0.05)。血氧饱和度及呼气末二氧化碳分压在两组间差异无统计学意义(P>0.05)。 结论 术中应用肺保护性通气策略对于麻醉及手术效果没有明显影响, 可以作为相对安全的选择方案。
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| 关 键 词： | 尘肺病 肺保护性通气 大容量肺灌洗 单肺通气 全身麻醉 动脉压 |
| 收稿时间： | 2017-06-30 |
Application of lung protective ventilation strategy in anesthesia for large volume lung lavage |
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| Abstract: | Objective To observe the effect of protective ventilation strategy in the treatment of large volume lung lavage. Methods Totally 60 patients with occupational pneumoconiosis were randomly divided into two groups:constant volume ventilation group(control group) and protective ventilation group(test group). The patients were received sequential induction, endobronchial intubation and general anesthesia. General anesthesia was maintained by intravenous anesthesia. The patients were given one-lung ventilation. Patients in the control group were treated with tidal volume(VT) 8-10 mL/kg, aspiratory rate(R) 12-14/min, fraction of inspiration O2 (FiO2)1.0, airway pressure 2.5-4 kPa, partial pressure of carbon dioxide in artery(PaCO2) 30-45 mmHg, while the patients in the test group treated with VT 6-8 mL/kg, R 14-16/min, FiO2 1.0, airway pressure 1.5-2.5 kPa, PaCO2 40-55 mmHg and positive end expiratory pressure (PEEP) 0.8-1.0 kPa. The mean arterial pressure, heart rate, pulse oxygen saturation and end tidal carbon dioxide partial pressure at each time point were compared between the two groups. Results The average arterial pressure of patients in the test group was higher than that in the control group during and after operation time(P < 0.05). The heart rate in the test group was higher than that in the control group after operation time(P < 0.05). There was no significant difference of blood oxygen saturation and carbon dioxide partial pressure between the two groups(P>0.05). Conclusion The application of lung protective ventilation strategy has no significant adverse effect on anesthesia and operation. It can be used as a safe and reliable choice. |
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