小潮气量机械通气对正常肺功能手术患儿呼吸力学及肺氧合功能的影响

摘要

目的：探讨小潮气量机械通气对正常肺功能手术患儿呼吸力学及肺氧合功能的影响。方法选取120例肺功能正常的骨科手术患儿，随机分为4组，每组30例。LV组：小潮气量7 mL/kg， LVP5组：小潮气量7 mL/kg＋5 cmH2 O PEEP，LVP10组：小潮气量7 mL/kg＋10 cmH2 O PEEP，CV组：常规潮气量10 mL/kg。分别于机械通气30 min及1 h后采集动脉血做血气分析，监测呼吸指数、氧合指数、A-aDo2、Cs、Cd，同时记录Peak、Plate数值。结果 LVP10组中T1和T2两个时间段的Peak值和Plat值明显高于其他三组，LVP5组中Cs、Cd明显高于其他三组，LV组Cs、Cd高于CV组，LV组OI明显高于其余三组，RI明显低于其他三组，A-aDO2随着时间的延长而下降，差异均有统计学意义（P＜0.05）。结论7 mL/kg小潮气量机械通气对正常肺功能患儿有肺保护作用，小潮气量复合5 cmH2 O低PEEP能够增加肺部顺应性，但未增加肺氧合功能。小潮气量复合10 cmH2 O高PEEP未发现有肺保护作用。%Objetive To study the influence of low tidal volume mechanical ventilation on the respirato-ry mechanics and pulmonary oxygenation function of children in operation with normal lung function. Methods To choose 1 20 cases of orthopedic surgery in children with normal lung function,were randomly divided into four groups,each group of 30 cases.LV group:a small tidal volume 7 mL/kg,LVP5 groups:small tidal vol-ume low peep:7+5 mL/kg cmH2 O PEEP,LVP1 0 groups:small tidal volume high PEEP group:7 mL/kg+1 0 cmH2 O PEEP,CV groups:conventional tidal volume 1 0 mL/kg.After mechanical ventilation 30 min and 1 h,respectively,doing arterial blood gas analysis and at the same time monitoring of respiratory index,oxygena-tion index,A-aDo2 ,Cs,Cd record Peak,Plat. Results LVP1 0 group T1 and T2 in the two periods of Peak values and plat,significantly higher than the other three groups,the Cs、Cd in LVP5 group was obviously higher than that of the other three groups,the Cs、Cd in LV group is higher than CV,the OI in LV group was obviously higher than that of the rest three groups,RI were significantly lower than the other three groups,as the extension of time A-aDO2 declined,the difference had statistical significance (P<0.05 ). Conclusion 7 mL/kg of low tidalvolume mechanical ventilation on pulmonary function in children with normal lung protection,low tidal volume compound 5 cmH2 O low PEEP can increase lung compliance ,but did not increase pulmonary oxygen-ation function.The lung protection of Low tidal volume compound 1 0 cmH2 O high PEEP has not been found .