【摘要】：研究背景：新生兒氣道不同于成人，由于其解剖結(jié)構(gòu)與氣道阻力構(gòu)成均與成人不同，胸廓短，氣管血管豐富，軟骨柔軟，支撐作用弱，，氣道纖毛運(yùn)動(dòng)差，易于出血，感染和呼吸道梗阻。同時(shí)新生兒也是生理變化最大的時(shí)候，對(duì)于缺氧敏感度較高。氣道壓過高的正壓通氣,可以作用于血管壁和肺泡,氣體進(jìn)入間質(zhì)組織,沿支氣管肺泡進(jìn)入縱膈而產(chǎn)生氣壓傷,以及吸氣末肺高容量可造成肺擴(kuò)張過度,導(dǎo)致?lián)p傷肺泡,增加毛細(xì)血管通透性,從而造成肺水腫，稱機(jī)械通氣致肺損傷(ventilator induced lung injury, VILI)。對(duì)比新生兒在全麻下使用喉罩和氣管插管時(shí)在不同通氣模式下氣道峰壓（PIP）與潮氣量（TV）的關(guān)系以及不同呼吸頻率的影響，目前相關(guān)報(bào)道不多見。 目的：對(duì)比新生兒在全麻下行腹部手術(shù)時(shí)使用喉罩和氣管插管時(shí)在壓力控制通氣（PCV）模式和容量控制通氣（VCV）下氣道峰壓（PIP）與潮氣量（TV）的關(guān)系以及不同呼吸頻率對(duì)呼末二氧化碳（PETCO_2）的影響。方法：行腹部手術(shù)的新生兒（出生24小時(shí)至28天）患者80例，出生時(shí)Apgar評(píng)分大于7分，體重大于2.5kg。吸入七氟醚麻醉后進(jìn)行氣管插管或置入喉罩，患兒按照隨機(jī)順序接受氣管插管或喉罩通氣，通氣期間給予監(jiān)測(cè)呼末二氧化碳及心電圖、血壓、血氧飽和度等生命指證監(jiān)測(cè)。每位患兒按隨機(jī)順序接受氣管插管和喉罩兩種人工氣道進(jìn)行通氣和不同的通氣模式通氣，呼吸頻率35次/分和40次/分,吸呼比1:2,呼氣末正壓通氣(PEEP)設(shè)置為5cmH_2O。呼吸機(jī)設(shè)定的吸氣壓力為分別14cmH_2O、16cmH_2O、18cmH_2O和20cmH_2O。設(shè)定吸氣壓力時(shí),同時(shí)測(cè)定PETCO_2波動(dòng)的范圍。通氣至少穩(wěn)定15min后記錄潮氣量、PETCO_2、HR、BP等呼吸和循環(huán)參數(shù)。所有參數(shù)測(cè)量3次后取均數(shù)表示。 結(jié)果：（1）在壓力模式通氣下氣道峰壓分別在14～18cmH_2O時(shí)，喉罩組和氣管插管組潮氣量和呼末二氧化碳值差異無統(tǒng)計(jì)學(xué)差異（P＞0.05）。氣道峰壓在20cmH_2O時(shí)，喉罩組和氣管插管組潮氣量差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。不同呼吸頻率下的呼末二氧化碳值沒有明顯差異(p0.05)（2）容量模式下，插管組和喉罩組在相同氣道峰壓時(shí)潮氣量沒有明顯差異(p0.05)，呼末二氧化碳值也沒有明顯差異(p0.05)。（3）在喉罩組中壓力模式和容量模式在氣道峰壓值分別在14～20cmH_2O時(shí)，潮氣量和呼末二氧化碳值的差異無統(tǒng)計(jì)學(xué)意義（P＞0.05） 結(jié)論：新生兒在全麻期間，喉罩與氣管插管在壓力通氣通氣模式下氣道峰壓為14～18cmH_2O均能安全等效的提供患兒所需的潮氣量并保證呼末二氧化碳的正常范圍。使用壓力控制模式通氣情況下壓力值在14～20cmH_2O時(shí)，氣管插管組和喉罩組相比通氣的潮氣量增加明顯。
[Abstract]:Background: neonatal airway is different from adults because of its different anatomical structure and airway resistance structure, short chest, abundant tracheal vessels, soft cartilage, weak support, poor airway cilia movement and easy bleeding. Infection and obstruction of respiratory tract. At the same time, the newborn is also the most physiological changes, high sensitivity to hypoxia. Positive airway pressure ventilation acts on the walls of blood vessels and alveoli, the gas enters the interstitial tissue, the air enters the mediastinum along the bronchoalveoli, and the high volume of the lungs at the end of inspiration can cause excessive pulmonary dilatation, leading to the injury of the alveoli. Increase capillary permeability, resulting in pulmonary edema, known as mechanical ventilation to cause lung injury (ventilator induced lung injury, VILI). To compare the relationship between peak airway pressure (PIP) and tidal volume (TV) during laryngeal mask and tracheal intubation in neonates under general anesthesia and the effects of different respiratory frequencies, there are few reports about the relationship between peak airway pressure (PIP) and tidal volume (TV) in different ventilation modes. Objective: to compare the relationship between peak airway pressure (PIP) and tidal volume (TV) under pressure controlled ventilation (PCV) and volume controlled ventilation (VCV) during laryngeal mask and tracheal intubation during abdominal surgery under general anesthesia. The effect of carbon dioxide (PETCO_2). Methods: 80 newborns (24 hours to 28 days old) underwent abdominal surgery. The Apgar score at birth was more than 7 and the weight was more than 2.5 kg. After inhaling sevoflurane anesthesia, tracheal intubation or laryngeal mask placement was performed, and the children were given tracheal intubation or laryngeal mask ventilation in random order. During ventilation, life indicators such as end-exhalation carbon dioxide, electrocardiogram, blood pressure and oxygen saturation were monitored. Each child was given tracheal intubation and larynx mask for ventilation and different ventilation modes in random order. The respiratory frequency was 35 / min and 40 / min, the breathing ratio was 1: 2, and the positive end-expiratory pressure (PEEP) was set to 5 cm H _ 2O. The inspiratory pressure set by ventilator is 14cmH _ 2O / 16cm H _ 2O _ 2O _ (18 cm H _ 2O) and 20cm H _ 2O _ 2 respectively. When the inspiratory pressure is set, the range of PETCO_2 fluctuations is also measured. Tidal volume, PETCO_2,HR,BP and other respiratory and circulatory parameters were recorded after ventilation at least after 15min. All parameters are measured 3 times and then the mean is expressed. Results: (1) there was no significant difference in tidal volume and end-exhalation carbon dioxide between laryngeal mask group and tracheal intubation group when peak airway pressure was in 14~18cmH_2O (P > 0. 05). There was significant difference in tidal volume between laryngeal mask group and tracheal intubation group when peak airway pressure was in 20cmH_2O (P < 0. 05). There was no significant difference in end-respiratory carbon dioxide values at different respiratory frequencies (p0.05) (2) volume mode. There was no significant difference in tidal volume between intubation group and laryngeal mask group at the same peak airway pressure (p0.05), and there was no significant difference in end-respiratory carbon dioxide value (p0.05). (3) in the laryngeal mask group when the peak airway pressure and volume mode were at 14~20cmH_2O, respectively. There was no significant difference in tidal volume and end-exhalation carbon dioxide (P > 0.05). Conclusion: during general anesthesia, there was no significant difference in tidal volume and carbon dioxide value (P > 0.05). Both laryngeal mask and endotracheal intubation can safely and effectively provide the required tidal volume and ensure the normal range of end-exhalation carbon dioxide when the peak airway pressure is 14~18cmH_2O in the pressure ventilation mode. The tidal volume of tracheal intubation group and laryngeal mask group increased significantly when the pressure value of 14~20cmH_2O was used in pressure control mode.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R726.1

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