甲基强的松龙对全身麻醉老年患者术中呼吸力学参数的影响及其临床意义

摘要

目的:研究甲基强的松龙(甲强龙)对全身麻醉插管行机械通气后老年患者呼吸力学参数的影响,探讨甲强龙是否可以改善老年患者呼吸系统退行性病变以及有利于机械通气.方法:将60例择期行开腹手术的老年患者按其意愿分为实验组和对照组(n=30).气管插管后实验组患者静脉注射甲强龙1 mL(40 mg),对照组患者静脉注射生理盐水1 mL.于给药前即刻和给药后10、20、30及40 min时记录2组患者气道峰压(Ppeak)、气道平台压(Pplat)、肺的顺应性(Compl)和气道阻力(Raw),在给药前即刻和给药后20 min时记录动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)和呼气末二氧化碳分压(PetCO2).结果:与给药前即刻比较,对照组患者给生理盐水后10、20、30和40 min时各呼吸力学参数比较差异无统计学意义(P>0.05);实验组患者在给药后10、20、30和40 min时 Compl明显升高(P<0.05),Ppeak、Pplat和Raw明显降低(P<0.05).与对照组比较,实验组患者在给药后10、20、30和40 min时Compl明显升高(P<0.05),Ppeak、Pplat和Raw明显降低(P<0.05).与给药前即刻比较,对照组患者给药后20 min时PaO2、PaCO2和PetCO2差异无统计学意义(P>0.05);实验组患者给药后20 min时PaCO2和PetCO2降低(P<0.05),PaO2升高(P<0.05).与对照组比较,实验组患者给药20 min时PaCO2和PetCO2降低(P<0.05),PaO2升高(P<0.05).结论:甲强龙可明显降低老年患者PaCO2、Ppeak、Pplat和Raw,增加PaO2和Compl;甲强龙能够改善老年患者呼吸系统退行性病变给全身麻醉带来的不利影响.%Objective:To observe the influence of methylprednisolone in the respiratory mechanical parameters in the elderly patients undergoing major surgeries with general anesthesia intubation after mechanical ventilation,and to investigate whether methylprednisolone can improve the respiratory system degenerative diseases and benefit the mechanical ventilation. Methods:Sixty patients undergoing elective line laparotomy were divided into experimental group and conrol group (n=30) according to their wishes.The patients in experimental group receieved intravenous injection of methylprednisolone 1 mL (40 mg) after endotracheal intubation,and the patients in control group receieved 1 mL intravenous saline water injection.The airway peak pressure (Ppeak), airway platform (Pplat), lung compliance (Compl), and airway resistance (Raw) of the patients in two groups were recorded at the time of immediately before administration and 10,20,30,40 min after administration.The arterial blood oxygen partial pressure(PaO2),arterial blood CO2 partial pressure(PaCO2),CO2 partial pressure at the end of breathe out(PetCO2) of the patients were detected at the time of immediately before administration and 20 min after administration.Results:Compared with before administration, the respiratory mechanics parameters of the patients in control group 10,20,30,40 min after administration had no statistically significant differences (P>0.05);the Comple of the patients in experimental group was singnificantly increased (P<0.05), and the Ppeak, Pplat,and Raw were significantly decreased (P<0.05).Compared with control group, the Compl of the patients in experiment group 10,20,30,and 40 min after administration were significantly increased (P<0.05),and the Ppeak, Pplat, and Raw were decreased (P<0.05).Compared with before administration,the PaO2,PaCO2,and PetCO2 of the patients in control group 20 min after administration had no significant differences(P>0.05);the PaCO2 and PetCO2 of the patients in experimental group 20 min after administration were decreased(P<0.05),and the PaO2 was increased(P<0.05).Compared with control group,the PaCO2 and PetCO2 of the patients in experimental group 20 min after administration were decreased(P<0.05),and the PaO2 was increased(P<0.05).Conclusion:Methylprednisolone can obviously reduce PaCO2,Peak, and Pplat and increase PaO2 and Compl;methylprednisolone has possibility in improving the adverse effects of degenerative disease of respiratory system on general anesthesia in the elderly patients.