中青年优秀论文评奖临床麻醉与研究双相气道正压结合反比通气应用.docVIP

中青年优秀论文评奖 临床麻醉与研究 双相气道正压结合反比通气应用于麻醉病人临床观察 王秀芹1 王培民1 郑刚2 1山东省肿瘤医院 250117 2 美国佛罗里达大学Shands Hospital 联系电话 王秀【】Ⅱ～Ⅲ级，术前无重大心肺疾病，排除人群：阻塞性肺病。所有病人均选择全身麻醉，气管插管后连接麻醉机，先以容量控制方式通气，吸呼比设为1:2，90分钟后转换到双相气道正压（SIMV-PC+PSV，其中，Psupport=0，病人无自主呼吸，可认为是双相气道正压），反比通气吸呼比设为2:1，即Tinspired设为4秒。PEEP从4cmH2O开始，Pinspired从7cmH2O开始，根据潮气量和呼气末CO2分压调整ΔP,每次增加或减少2cmH2O。并选择取得相同潮气量时ΔP最小时的Pinspired、PEEP值作为术中病人持续机械通气的压力。保持与容量控制通气相同的潮气量。记录气道峰值压力（Pmax）、平均气道压力（Pmean）、呼气末CO2分压，血压、心率、脉搏氧饱和度变化，计算肺的顺应性并在每一种通气方式90分钟稳定后抽取桡动脉血测血气分析。结果 双相气道正压结合反比通气时，Pmean明显升高，肺的顺应性明显升高，与容量控制通气相比，P＜0.001，差异有统计学意义。气道峰压及动脉血二氧化碳分压、氧分压、血流动力学差异无统计学意义。结论 双相气道正压结合反比通气应用于全麻病人，平均气道压显著升高，肺的顺应性明显改善，对血流动力学无显著影响，可安全用于全麻病人术中机械通气维持。 【】consent were obtained.During surgery,a period of greater than 3 hours of mechnical ventilation was anticipated. The patients were mechanically ventilated(VT 6-8ml/kg,RR 10bpm,).PETCO2 was maintained at 35-45mm Hg.The inspired oxygen concentration is 100%.The patients抣ungs were ventilated with volume control ventilation (I:E 1:2) firstly and then swithed to biphasic positive airway pressure in combination with inverse ratio ventilation(SIMV-PC+PSV,Psupport=0 I:E 2:1 no spontaneous ventilation) after 90 minutes. Tinspired was 4 seconds.Basic setting included PEEP started from 4cmH2O and Pinspired started from 7cmH2O.ΔP was adjusted according to VT and PETCO2 .Increasing two pressure levels by 2 cmH2O until a maximal VT was observed facilitates pressure settings.However, VT should not be more than 6-8mL/kg ideal body weight.Keep the same VT with volume control.Hemodynamics,Pmax,Pmean and PETCO2 were studied.Arterial blood gas was measured after 90min during each kinds of ventilations.Lung compliance was calculated. Resuls: Pmean and CL were significantly increased during biphasic positive airway pressure in combination with inverse ratio ventilation as compared with during volume c