本文選題：肺保護(hù)性通氣策略 + 小潮氣量　； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的通過(guò)在腹腔鏡盆腔手術(shù)麻醉過(guò)程中對(duì)患者實(shí)施肺復(fù)張手法后對(duì)潮 氣量（VT）、呼吸頻率（f）、吸氣呼氣時(shí)間比（I:E）、呼氣末正壓（PEEP）四項(xiàng)呼吸參數(shù)進(jìn)行不同水平的組合設(shè)定，觀察其對(duì)患者術(shù)中呼吸功能的影響，探討腹腔鏡盆腔手術(shù)麻醉時(shí)應(yīng)用肺保護(hù)性通氣策略的理想通氣參數(shù)組合。 方法選擇36例行擇期腹腔鏡宮頸癌根治術(shù)手術(shù)患者，ASA分級(jí)I～Ⅱ級(jí)，按四因素三水平重復(fù)正交試驗(yàn)設(shè)計(jì)分為九組，每組四例患者。每例患者均行全憑靜脈麻醉，術(shù)中行間歇正壓通氣。在建立穩(wěn)定的二氧化碳?xì)飧辜罢{(diào)整體位后，對(duì)每例患者均實(shí)施肺復(fù)張手法，之后恢復(fù)機(jī)控通氣，同時(shí)按設(shè)定的試驗(yàn)分組調(diào)節(jié)相應(yīng)的呼吸參數(shù)。四因素設(shè)定為潮氣量（A）、呼吸頻率（B）、吸氣呼氣時(shí)間比（C）、呼氣末正壓（D）,各因素水平設(shè)定為1、2、3三水平。監(jiān)測(cè)患者麻醉前、氣腹前、氣腹后60分鐘的MAP，HR，SPO2, PETCO2及PIP和Pmean等。于氣腹開始前及氣腹后60分鐘分別抽取橈動(dòng)脈血做血?dú)夥治觥?結(jié)果⑴各組患者手術(shù)均順利完成，試驗(yàn)過(guò)程中患者心率、血壓平穩(wěn)，血氧飽和度監(jiān)測(cè)97-100％。其中3例患者術(shù)中出現(xiàn)偶發(fā)室性早搏，血流動(dòng)力學(xué)平穩(wěn)，未予特殊處理。所有患者ECG監(jiān)測(cè)未發(fā)現(xiàn)心肌缺血表現(xiàn)。氣腹60分鐘時(shí)各組患者HR、MAP、PaO2之間比較無(wú)統(tǒng)計(jì)學(xué)差異。 ⑵極差分析結(jié)果： ①四因素對(duì)PaCO2的影響程度大小是：fVTPEEPI:E,使PaCO2較低的最優(yōu)組合是：f=18次/min,VT=12ml/kg,I:E=1:2,PEEP=10cmH2O； ②四因素對(duì)PIP的影響程度大小是VTPEEPI:Ef，使PIP較低的最優(yōu)組合是：f=10次/min,VT=6ml/kg,I:E=2:1,PEEP=4cmH20； ③四因素對(duì)Pmean的影響程度大小是PEEPI:EVTf，使Pmean較低的最優(yōu)組合是：f=10次/min,VT=6ml/kg,I:E=1:2,PEEP=4cmH20。 ⑶方差分析結(jié)果： ①VT、f、PEEP的不同水平對(duì)PaCO2的影響存在顯著統(tǒng)計(jì)學(xué)意義(PO.01)，I:E的不同水平對(duì)PaCO2的影響沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05)； ②四因素的不同水平對(duì)PIP的影響均存在顯著統(tǒng)計(jì)學(xué)意義(PO.01)； ③四因素的不同水平對(duì)Pmean的影響均存在顯著統(tǒng)計(jì)學(xué)意義(PO.01)。 結(jié)論全身麻醉下腹腔鏡盆腔手術(shù)患者行肺復(fù)張手法后的理想術(shù)中通氣組合模式為A1B3C3D1，，即VT=6ml/kg，f=18次/min，I:E=1:2，PEEP=4cmH2O。
[Abstract]:Objective to set different levels of respiratory parameters such as tidal volume, respiratory frequency, inspiratory and expiratory time ratio (I / E) and positive end-expiratory pressure (PEEP) during laparoscopic pelvic anaesthesia. To observe the effect of lung protective ventilation on the respiratory function of patients during laparoscopic pelvic surgery, and to explore the ideal ventilation parameter combination of lung protective ventilation strategy during laparoscopic pelvic surgery. Methods A total of 36 patients undergoing laparoscopic radical cervical cancer surgery were divided into nine groups according to four factors and three levels repeated orthogonal design. Each patient received total intravenous anesthesia and intermittent positive pressure ventilation. After establishing stable carbon dioxide pneumoperitoneum and adjusting body position, each patient was treated with pulmonary retensioning manipulation, and then the mechanical ventilation was restored, and the corresponding respiratory parameters were adjusted according to the set test group at the same time. Four factors were determined as tidal volume, respiratory frequency, inspiratory expiratory time ratio, positive end-expiratory pressure and three levels. MAPHRO _ 2, PET _ 2, PIP and Pmean were monitored before anesthesia and 60 minutes after pneumoperitoneum. Radial artery blood was collected before pneumoperitoneum and 60 minutes after pneumoperitoneum for blood gas analysis. Results 1 the operation was completed successfully in each group. The heart rate, blood pressure and blood oxygen saturation were stable, and the blood oxygen saturation was monitored 97-100 in the course of the experiment. Among them, 3 cases had occasional ventricular premature beat during operation, the hemodynamics was stable and no special treatment was given. No myocardial ischemia was found by ECG monitoring in all patients. At 60 minutes after pneumoperitoneum, there was no statistical difference between the two groups. 2 the results of the range difference analysis showed that: 1 the influence of four factors on Paco _ 2 was: (1) the degree of influence of four factors on Paco _ 2 was: 1: fVTPEEPI: e, the best combination with lower Paco _ 2 was 12 ml / kg I-1: E1: 2 / PEEP10cmH _ 2O; (2) the influence of four factors on PIP is VTPE EPI: Ef. the best combination with lower PIP is: 10 / min / min VTT = 6 ml / kg / kg = 2: 1 PEEPI = 4cmH20; 3 the degree of influence of four factors on Pmean is PEEPI: EVTf. the best combination with lower Pmean is: 10 / min / min VT = 6 ml / kg / kg = 1: 1: 2 / PEEP 4cm H20.3 ANOVA results: 1VTfpeep has significant effect on PaCO2 at different levels. The effect of different levels of I: e on PaCO2 was not statistically significant (P 0.05). (2) the influence of four factors on PIP was statistically significant (P < 0.01), and the influence of four factors on Pmean was statistically significant (P < 0.01). Conclusion the ideal intraoperative ventilation combination model for patients undergoing laparoscopic pelvic surgery under general anesthesia is A1B3C3D1, that is, VTT 6ml / kg / min / min I / e 1: 2PEEPN 4cm H _ 2O.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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