發(fā)布時(shí)間：2018-01-24 21:04

  本文關(guān)鍵詞： 小潮氣量 機(jī)械通氣 肺換氣 動(dòng)靜脈氧分壓差 肺泡-動(dòng)脈氧分壓差 肺內(nèi)分流率　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過(guò)采集全麻手術(shù)患者在小潮氣量機(jī)械通氣和常用潮氣量通氣下的動(dòng)靜脈血?dú)鈾z測(cè)數(shù)據(jù),計(jì)算動(dòng)靜脈氧分壓差、肺泡動(dòng)脈氧分壓差和肺內(nèi)分流率等,觀察小潮氣量機(jī)械通氣對(duì)全麻手術(shù)患者肺換氣功能的影響,探索有利于全麻手術(shù)患者的潮氣量。方法按照設(shè)定的納入和排除標(biāo)準(zhǔn),選取2015年3月至2016年9月在解放軍306醫(yī)院行擇期手術(shù)的患者80例,其中仰臥位手術(shù)42例,俯臥位手術(shù)38例,ASA分級(jí)均是Ⅰ或Ⅱ級(jí),將全部試驗(yàn)對(duì)象的80例患者記為Total Subject,仰臥位記為Supine Group,俯臥位記為Prone Group。所有的患者均采用全憑靜脈全身麻醉,麻醉誘導(dǎo)完成后,設(shè)置機(jī)械通氣參數(shù)為容量控制模式,吸入氧流量為2L/min,設(shè)置潮氣量(VT)為8 ml/kg(不同的組別分別為T8,S8和P8組),呼吸頻率為10次/分,30min后行動(dòng)脈血?dú)夥治?同時(shí)將VT設(shè)置為6 ml/kg(不同的組別分別為T6,S6和P6組),呼吸頻率為13次/分,30min后再次行動(dòng)脈血?dú)夥治�。收集記錄研究過(guò)程中生命體征及血?dú)夥治霰O(jiān)測(cè)數(shù)據(jù),計(jì)算動(dòng)靜脈氧分壓差(Pa-v O2)、肺泡動(dòng)脈氧分壓(PA-aO2)及肺內(nèi)分流率(QS/QT)。對(duì)收集的資料應(yīng)用SPSS 19.0醫(yī)學(xué)統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)分析論證。符合正態(tài)分布的計(jì)量資料,采用均數(shù)±標(biāo)準(zhǔn)差(MEAN±SD)表示;多組間(≥2組)均數(shù)的比較,采用單因素重復(fù)測(cè)量方差分析進(jìn)行檢驗(yàn)。所采用的全部檢驗(yàn)方法,均定義P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果在全麻手術(shù)中給予機(jī)械通氣的情況下:(1)不考慮體位的影響時(shí),VT為8ml/kg時(shí),Pa-v O2為(402.10±103.55mm Hg),VT為6ml/kg時(shí),Pa-v O2為(419.70±73.13mm Hg),P=0.2220.05,即不分體位時(shí),T8與T6對(duì)Pa-v O2的影響無(wú)明顯差別。潮氣量為8ml/kg時(shí)的PA-a O2為(206.3±100.01mm Hg),潮氣量6ml/kg時(shí)PA-a O2為(177.45±175.62mm Hg),P=0.0690.05,即不分體位時(shí),T8與T6對(duì)PA-a O2的影響無(wú) 明顯差別。潮氣量為8ml/kg時(shí)QS/QT為(11.10±4.66%),潮氣量6ml/kg時(shí)QS/QT為(9.76±3.83%),P=0.0620.05,即T8與T6對(duì)QS/QT的影響無(wú)明顯差別。(2)仰臥位時(shí),VT為8ml/kg時(shí),Pa-v O2為(388.85±95.16mm Hg),VT為6ml/kg時(shí),Pa-v O2為(404.00±74.52mm Hg),P=0.2690.05,即仰臥位時(shí),S8與S6對(duì)Pa-v O2的影響無(wú)明顯差別。仰臥位時(shí),潮氣量為8ml/kg時(shí)的PA-a O2為(221.27±92.73mm Hg),潮氣量6ml/kg時(shí)PA-a O2為(199.17±92.73mm Hg),P=0.1670.05,即仰臥位時(shí),S8與S6對(duì)PA-a O2的影響無(wú)明顯差別。潮氣量為8ml/kg時(shí)QS/QT為(11.86±4.28%),潮氣量6ml/kg時(shí)QS/QT為(10.87±3.43%),P=0.1610.05,即S8與S6對(duì)QS/QT的影響無(wú)明顯差別(3)俯臥位時(shí),VT為8ml/kg時(shí),Pa-v O2為(426.71±121.48mm Hg),VT為6ml/kg時(shí),Pa-v O2為(448.86±65.62mm Hg),P=0.320.05,即俯臥位時(shí),P8與P6對(duì)Pa-v O2的影響無(wú)明顯差別。俯臥位時(shí),潮氣量為8ml/kg時(shí)的PA-a O2為(178.85±114.39mm Hg),潮氣量6ml/kg時(shí)PA-a O2為(137.11±74.20mm Hg),P=0.2680.05,即俯臥位時(shí),P8與P6對(duì)PA-a O2的影響無(wú)明顯差別。潮氣量為8ml/kg時(shí)QS/QT為(9.67±5.33%),潮氣量6ml/kg時(shí)QS/QT為(7.69±3.92%),P=0.2480.05,即P8與P6對(duì)QS/QT的影響無(wú)明顯差別。(4)VT為8ml/kg時(shí),仰臥位時(shí)的Pa-v O2為(388.85±95.16mm Hg),俯臥位時(shí)的Pa-v O2為(426.71±121.48mm Hg),P=0.4500.05,即潮氣量為8ml/kg時(shí),仰臥位對(duì)Pa-v O2的影響較俯臥位時(shí)無(wú)明顯差別;潮氣量為8ml/kg時(shí),仰臥位時(shí)的PA-a O2為(221.27±92.73mm Hg),俯臥位時(shí)的PA-a O2為(178.85±114.39mm Hg),P=0.4140.05,即潮氣量為8ml/kg時(shí),仰臥位對(duì)PA-a DO2的影響較俯臥位無(wú)明顯差別;潮氣量為8ml/kg時(shí),仰臥位QS/QT為(11.86±4.28%),俯臥位時(shí)的QS/QT為(9.67±5.33%),P=0.3290.05,即潮氣量為8ml/kg時(shí),仰臥位對(duì)QS/QT的影響較俯臥位無(wú)明顯差別。(5)VT為6ml/kg時(shí),仰臥位時(shí)的Pa-v O2為(404.00±74.52mm Hg),俯臥位時(shí)的Pa-v O2為(448.86±65.62mm Hg),P=0.1990.05即潮氣量為6ml/kg時(shí),仰臥位對(duì)Pa-v O2的影響較俯臥位時(shí)無(wú)明顯差別;潮氣量為6ml/kg時(shí),仰臥位時(shí)的PA-a O2為(199.17±92.73mm Hg),俯臥位時(shí)的PA-a O2為(137.11±74.20mm Hg),P=0.0790.05,即潮氣量為6ml/kg時(shí),仰臥位對(duì)PA-a O2的影響較俯臥位無(wú)明顯差別;潮氣量為6ml/kg時(shí),仰臥位QS/QT為(10.87±3.43%),俯臥位時(shí)的QS/QT為(7.69±3.92%),P=0.0750.05,即潮氣量為6ml/kg時(shí),仰臥位對(duì)QS/QT的影響較俯臥位無(wú)明顯差別。結(jié)論從肺換氣功能的角度來(lái)考慮,不論患者是仰臥位還是俯臥位,小潮氣量與常用潮氣量對(duì)肺換氣功能的影響都沒(méi)有明顯區(qū)別,即小潮氣量機(jī)械通氣可以安全地應(yīng)用于全麻手術(shù)患者。
[Abstract]:Objective To study the effects of small tidal volume mechanical ventilation on pulmonary ventilation in patients with general anesthesia by measuring the effects of small tidal volume mechanical ventilation on pulmonary ventilation function in patients with general anesthesia . When tidal volume was 8ml / kg , PA - a O2 was ( 206.3 鹵 100.01mm Hg ) , tidal volume 6ml / kg PA - a O2 was ( 177.45 鹵 175.62mm Hg ) , P = 0.060.05 , i.e . , when the tidal volume was 8ml / kg , QS / QT was ( 11.10 鹵 4.66 % ) , tidal volume 6ml / kg , QS / QT was ( 9.76 鹵 3.83 % ) , P = 0.0620 . 05 , that is , T8 and T6 had no significant difference on QS / QT . When the tidal volume was 8 ml / kg , the PA - a O2 at 8 ml / kg was ( 11.86 鹵 92.73 mm Hg ) , P = 0.1670.05 , that is , the PA - a O2 at 8 ml / kg was ( 174.86 鹵 12.73 mm Hg ) , P = 0.1670.05 , that is , the PA - a O2 was ( 137.11 鹵 74.20 mm Hg ) at 6 ml / kg , P = 0.2680.05 , that is , when lying prone position , When the tidal volume was 8ml / kg , the supine position had no significant difference between the supine position and the supine position when the tidal volume was 8ml / kg . When the tidal volume was 6 ml / kg , the supine position was ( 10.87 鹵 3.92 % ) , P = 0.070.05 , that is , when the tidal volume was 6 ml / kg , the supine position had no significant difference in the influence of the supine position on the pulmonary ventilation function .

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614.2

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