低流量定量麻醉的可行性研究
發(fā)布時間：2018-11-14 15:32
【摘要】：目的將低流量吸入麻醉技術(shù)與定量麻醉的計算方法和呼吸環(huán)路內(nèi)給藥方法相結(jié)合，觀察和分析該吸入麻醉給藥方法的可行性和準(zhǔn)確性。 方法本研究采用前瞻性、隨機、對照、單盲試驗的設(shè)計方法，將符合本試驗標(biāo)準(zhǔn)的30例患者納入研究。根據(jù)載氣量的不同，將研究對象隨機均分兩組，載氣量1000ml/min為A組（n=15）、載氣量800ml/min為B組(n=15)。靜脈麻醉誘導(dǎo)氣管插管后靜吸復(fù)合維持麻醉，瑞芬太尼2-6ng/ml靶控輸注，，將液態(tài)揮發(fā)性麻醉藥異氟烷在呼吸環(huán)路的呼氣端輸注至呼吸回路內(nèi)。異氟烷的輸注量由兩部分組成，第一部分根據(jù)定量麻醉的計算方法，計算出維持異氟烷0.8最低肺泡有效濃度（MAC）所需的預(yù)充量和單位量，第二部分是超出機體氧耗量的載氣所需藥量，兩部分輸注藥量均按維持0.8最低肺泡有效濃度（minimumalveolar concentration,MAC）計算。每5min記錄兩組呼吸環(huán)路內(nèi)吸入氣麻醉藥濃度（Fi）、呼出氣麻醉藥的濃度（Fe）、MAC、吸入氧濃度(FiO2)、呼氣末二氧化碳（PETCO2）。應(yīng)用偏離性（MDPE）、精確度（MDAPE）和擺動度(WOBBLE)評價兩組給藥系統(tǒng)的準(zhǔn)確性。 結(jié)果兩組患者一般情況比較差異無統(tǒng)計學(xué)意義(P＞0.05)。術(shù)中兩組間FiO2、PETCO2比較差異有統(tǒng)計學(xué)意義(P＜0.05)，A組FiO2平均值大于B組，A組PETCO2平均值小于B組。兩組間異氟烷呼氣末濃度Fe、MAC、MDPE、MDAPE、擺動度的比較差異無統(tǒng)計學(xué)意義(P＞0.05)。將兩組MAC與標(biāo)準(zhǔn)值0.8相比較，差異無統(tǒng)計學(xué)意義(P＞0.05)，兩組MDPE與標(biāo)準(zhǔn)值0相比較，差異無統(tǒng)計學(xué)意義(P＞0.05)。A組10%～90%MDPE、MDAPE的累計頻率分布范圍分別為-12.5%～8.75%、0%～12.5%，B組分別為-12.5%~12.5%和0%～12.5%，均在臨床可接受范圍。兩組間異氟烷Fi的比較差異有統(tǒng)計學(xué)意義(P＜0.05), A組大于B組。 結(jié)論采用定量麻醉的計算方法，將呼吸環(huán)路內(nèi)變速輸注液態(tài)揮發(fā)性吸入麻醉藥的方法與低流量吸入麻醉技術(shù)相結(jié)合，可以使環(huán)路內(nèi)吸入麻醉藥物濃度快速上升，并能維持呼吸環(huán)路內(nèi)吸入麻醉藥物濃度在設(shè)定值水平。編制的定量麻醉計算程序的準(zhǔn)確性得到了驗證。
[Abstract]:Objective to observe and analyze the feasibility and accuracy of low flow inhalation anesthesia, quantitative anesthesia and respiratory loop administration. Methods A prospective, randomized, controlled, single blind trial was used to study 30 patients who met the criteria of this study. According to the difference of carrier gas volume, the subjects were randomly divided into two groups: group A (1000ml/min) and group B (800ml/min). After induction of endotracheal intubation by intravenous anesthesia, intravenous inhalation combined with maintenance anesthesia, remifentanil 2-6ng/ml target controlled infusion, the liquid volatile anesthetic isoflurane was injected into the respiratory loop at the end of the breath loop. The infusion of isoflurane consists of two parts. In the first part, the precharge and unit amount required to maintain the minimum alveolar effective concentration (MAC) of isoflurane 0.8 are calculated according to the calculation method of quantitative anesthesia. The second part is about the amount of gas needed in excess of the amount of oxygen consumed by the body. Both of the two parts are calculated according to the maintenance of the minimum alveolar effective concentration (minimumalveolar concentration,MAC) of 0. 8. Each 5min recorded the concentration of inhaled anesthetics in two groups in the respiratory loop. The concentration of (Fe), MAC, inhaled oxygen (FiO2) and end-expiratory carbon dioxide (PETCO2) were recorded in (Fi), exhaled anesthetic. Deviation (MDPE), accuracy (MDAPE) and swing degree (WOBBLE) were used to evaluate the accuracy of two groups of drug delivery systems. Results there was no significant difference in general condition between the two groups (P > 0.05). There was significant difference in FiO2,PETCO2 between the two groups during operation (P < 0. 05). The average value of FiO2 in group A was higher than that in group B (P < 0. 05), and the average value of PETCO2 in group A was lower than that in group B. There was no significant difference in Fe,MAC,MDPE,MDAPE, swing between the two groups (P > 0. 05). There was no significant difference in MAC between the two groups (P > 0. 05), but there was no significant difference in MDPE between the two groups compared with the standard value 0 (P > 0. 05). A). The accumulative frequency distribution range of MDAPE was -12.5% and -12.75%, respectively, and 12.5% and 12.5% in group B, respectively, which were both in the range of clinical acceptability. The difference of isoflurane Fi between the two groups was statistically significant (P < 0. 05). Conclusion the method of quantitative anaesthesia and the combination of variable velocity infusion of liquid volatile inhaled anesthetic in respiratory loop and low flow inhalation anesthesia technology can make the concentration of inhaled anesthetic in the loop rise rapidly. The concentration of inhaled anesthetic in respiratory loop can be maintained at the set level. The accuracy of the program was verified.
【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
本文編號：2331574
[Abstract]:Objective to observe and analyze the feasibility and accuracy of low flow inhalation anesthesia, quantitative anesthesia and respiratory loop administration. Methods A prospective, randomized, controlled, single blind trial was used to study 30 patients who met the criteria of this study. According to the difference of carrier gas volume, the subjects were randomly divided into two groups: group A (1000ml/min) and group B (800ml/min). After induction of endotracheal intubation by intravenous anesthesia, intravenous inhalation combined with maintenance anesthesia, remifentanil 2-6ng/ml target controlled infusion, the liquid volatile anesthetic isoflurane was injected into the respiratory loop at the end of the breath loop. The infusion of isoflurane consists of two parts. In the first part, the precharge and unit amount required to maintain the minimum alveolar effective concentration (MAC) of isoflurane 0.8 are calculated according to the calculation method of quantitative anesthesia. The second part is about the amount of gas needed in excess of the amount of oxygen consumed by the body. Both of the two parts are calculated according to the maintenance of the minimum alveolar effective concentration (minimumalveolar concentration,MAC) of 0. 8. Each 5min recorded the concentration of inhaled anesthetics in two groups in the respiratory loop. The concentration of (Fe), MAC, inhaled oxygen (FiO2) and end-expiratory carbon dioxide (PETCO2) were recorded in (Fi), exhaled anesthetic. Deviation (MDPE), accuracy (MDAPE) and swing degree (WOBBLE) were used to evaluate the accuracy of two groups of drug delivery systems. Results there was no significant difference in general condition between the two groups (P > 0.05). There was significant difference in FiO2,PETCO2 between the two groups during operation (P < 0. 05). The average value of FiO2 in group A was higher than that in group B (P < 0. 05), and the average value of PETCO2 in group A was lower than that in group B. There was no significant difference in Fe,MAC,MDPE,MDAPE, swing between the two groups (P > 0. 05). There was no significant difference in MAC between the two groups (P > 0. 05), but there was no significant difference in MDPE between the two groups compared with the standard value 0 (P > 0. 05). A). The accumulative frequency distribution range of MDAPE was -12.5% and -12.75%, respectively, and 12.5% and 12.5% in group B, respectively, which were both in the range of clinical acceptability. The difference of isoflurane Fi between the two groups was statistically significant (P < 0. 05). Conclusion the method of quantitative anaesthesia and the combination of variable velocity infusion of liquid volatile inhaled anesthetic in respiratory loop and low flow inhalation anesthesia technology can make the concentration of inhaled anesthetic in the loop rise rapidly. The concentration of inhaled anesthetic in respiratory loop can be maintained at the set level. The accuracy of the program was verified.
【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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