【摘要】：目的探討潮氣量(tidal volume, Vt)對脈搏氧指容積波波幅變異度(respiratoryvariation in pulse oximetry plethysmographic waveform amplitude, dPOP)的影響。方法選擇全身麻醉的手術(shù)患者50例，采取自身對照原則，每位患者給予相同的麻醉方法及干預(yù)措施。開放靜脈以10mL·kg-1·h-1的速率輸注乳酸林格氏液，快誘導(dǎo)氣管插管后，設(shè)定初始Vt=8mL/kg、I:E=1:2、f=12次/分、PEEP=0。以1%異氟醚復(fù)合2～8ng/L靶濃度的瑞芬太尼維持麻醉，調(diào)整麻醉藥濃度使CSI值在40～60之間。機(jī)械通氣3min后，根據(jù)隨機(jī)數(shù)字表確定先后給予Vt為6mL/kg、9mL/kg、12mL/kg機(jī)械通氣的順序，，每一干預(yù)Vt分別維持3min，并記錄干預(yù)前后的血流動力學(xué)參數(shù)及呼吸動力學(xué)參數(shù)。光電監(jiān)護(hù)儀同時記錄脈搏氧指容積波(pulse oximetry plethysmograph, POP)及呼氣末二氧化碳曲線，NICOM監(jiān)護(hù)儀監(jiān)測HR、SBP、DBP、MAP、心臟指數(shù)(cardiac Index, CI)、每搏量指數(shù)(stroke volume index, SVI)、每搏量變異度(stroke volume variation, SVV)等參數(shù)。根據(jù)公式計算dPOP。結(jié)果剔除病歷11例，納入研究39例。Vt為12mL/kg與6mL/kg機(jī)械通氣后比較：CI、SVI降低，SVV、dPOP、氣道峰壓(peak airway pressure, Ppeak)、氣道平臺壓(plat airway pressuer, Pplat)升高，兩組間比較差異有統(tǒng)計學(xué)意義(P＜0.05)。Vt為9mL/kg與6mL/kg機(jī)械通氣后比較，Vt為12mL/kg與9mL/kg機(jī)械通氣后比較：SVV、dPOP、Ppeak、Pplat均升高，組間比較差異有統(tǒng)計學(xué)意義(P＜0.05)。Vt為6mL/kg、9mL/kg、12mL/kg機(jī)械通氣后，dPOP與SVV有良好線性相關(guān)(P＜0.05)，相關(guān)系數(shù)分別為0.684、0.817、0.699。dPOP與3個干預(yù)Vt有顯著線性相關(guān)(P＜0.05)，相關(guān)系數(shù)分別為0.428、0.638、0.543。結(jié)論Vt可以影響dPOP的準(zhǔn)確性。
[Abstract]:Objective to investigate the effect of tidal volume (tidal volume, Vt) on pulse oxygen finger volume wave amplitude variability (respiratoryvariation in pulse oximetry plethysmographic waveform amplitude, dPOP). Methods A total of 50 patients undergoing general anesthesia were treated with the principle of self-control. Each patient was given the same anesthetic method and intervention. Open vein was infused with Ringer lactate solution at the rate of 10mL kg-1 h-1. After induction of tracheal intubation, initial Vt=8mL/kg,I:E=1:2,f=12 times / min, PEEP=0. were set. Remifentanil with 1% isoflurane and 2~8ng/L target concentration was used to maintain anesthesia and adjust the concentration of anesthetic to make the CSI value between 40 and 60. After mechanical ventilation (3min), the sequence of mechanical ventilation with Vt of 6 mL / kg / kg or 9 mL / kg or 12 mL / kg was determined according to random number table. Each intervention Vt was maintained for 3 minutes, and the hemodynamic parameters and respiratory parameters before and after intervention were recorded. The pulse oxygen finger volume wave (pulse oximetry plethysmograph, POP) and end-expiratory carbon dioxide (end-expiratory carbon dioxide) curves were recorded by the photoelectric monitor. The HR,SBP,DBP,MAP, cardiac index (cardiac Index, CI), the volume index (stroke volume index, SVI), the variability per stroke (stroke volume variation, SVV), and so on were monitored by the NICOM monitor. Calculating dPOP. according to formula Results 11 cases were excluded and 39 cases were included in the study. Vt was compared with that of 6mL/kg after mechanical ventilation: CI,SVI decreased, and (peak airway pressure, Ppeak), airway plateau pressure of SVV,dPOP, increased. There was a significant difference between the two groups (P < 0. 05) (P < 0. 05). There was a significant difference between the two groups (P < 0. 05) after 9mL/kg and 6mL/kg mechanical ventilation, and Vt was compared with 12mL/kg and 9mL/kg after mechanical ventilation. There was a significant linear correlation between dPOP and SVV after mechanical ventilation (P < 0. 05). The correlation coefficients were 0. 684 ~ 0. 817 ~ 0. 699. 9 d pop and 3 intervention Vt (P < 0. 05). The correlation coefficients were 0. 428, 0. 638 and 0. 543 respectively. Conclusion Vt can affect the accuracy of dPOP.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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