呼气末正压通气对骨肿瘤手术患者全身麻醉期间呼吸功能及血流动力学的影响分析

目的探讨呼气末正压通气(PEEP)对骨肿瘤患者全麻手术期间呼吸功能及血流动力学的影响。方法选取2013年1月至2014年1月进行全麻下骨肿瘤手术的ASA分级Ⅰ^Ⅱ级的骨肿瘤患者30例,随机分为观察组和对照组,每组15例。所有患者进行常规麻醉诱导后行机械通气,待循环和容量状态稳定后,对照组增加PEEP 8cm H2O,观察组不增加。记录和比较两组患者在术前、麻醉插管后15min、麻醉插管后30min和拔管后的呼吸功能指标气道峰压(Ppeak)、气道平台压(Ppla、PaO2和PaCO2)]和血流动力学指标心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)]。结果两组组内比较显示,随时间推移,对照组内Ppeak和Ppla显著增加,差异有统计学意义(P<0.01),而观察组内Ppeak和Ppla差异无统计学意义(P>0.05)。两组PaO2值随时间推移均下降(P<0.05),HR、MAP及CVP值差异均无统计学意义(P>0.05)。相同时间点两组间比较显示,与观察组比较,对照组的PaO2值、Ppeak及Ppla明显增加(P<0.05),PaCO2、CVP、HR、MAP值差异无统计学意义(P>0.05)。结论全麻下骨肿瘤患者手术期间应用PEEP,可增加PaO2、Ppeak及Ppla,改善患者的呼吸功能,但对患者的血流动力学指标无明显影响。在全麻骨肿瘤患者手术中,适当进行PEEP通气有应用价值。

Analysis the effects of PEEP on respiratory function and hemodynamics during general anesthesia surgery of patients with bone tumors

Objective To study the effects of positive end expiratory pressure （PEEP） on respirato- ry function and hemodynamics during general anesthesia surgery of patients with bone tumors. Methods Selected 30 patients with bone tumors who received general anesthesia surgery from January 2013 to January 2014. All patients were ASA class I or II. Randomly divided them into the observation group and the control group ,with 15 cases in each group. All patients were given mechanical ventilation after general anesthesia induction, and gave patients of control group PEEP ventilation 8cm H20. Recorded and compared respirato- ry function indexes （ Ppeak,Ppla,PaO2 ,PaCO2 ） and hemodynamic indexes （HR,MAP,CVP） of patients at different times （ TO ： preoperative, T1 ： 15 min after anesthesia intubation, T2：30 min after intubation anes- thesia, 33 ： after extubation） . Results Within the two groups ： as time going by, Ppeak and Ppla of obser- vation group increased significantly （ P 〈 0. 01 ）, while there was no statistically significant difference of Ppeak and Ppla in observation group （P 〉0. 05） ; PaO2 decreased （P 〈0. 05） ; HR,MAP,CVP had no sta- tistical difference （P 〉 0. 05 ） . Between the two groups ： PaO2 , Ppeak, Ppla and CVP of control group in-creased significantly （ P 〈 0. 05 ）, while PaCO2, CVP, HR, MAP had no statistically significant difference （P 〉 0. 05）. Conclusions The application of PEEP in general anesthesia surgery of patients with bone tumors increases PaO2 ,Ppeak and Ppla,improving patient s ＇respiratory function. But the patients ＇hemody- namic parameters are not changed significantly. There is application value of PEEP in general anesthesia surgery of patients with bone tumors.