不同通气方法对全麻俯卧位脊柱手术老年患者围术期呼吸功能的影响

摘要

Objective To investigate the effect of different ventilation methods on perioperative respiratory function of elderly patients in prone positioning general anesthesia undergoing spinal surgery. Methods Sixty ASA Ⅰor Ⅱ elderly patients aged 65~75 years,weight 50~80 kg and BMI≤25 kg/m2 of both sexes undergoing elective spi-nal surgery under prone positioning in general anesthesia,were randomly divided into 3 groups (n=20):group C (Vt:10 mL/kg); group LV (Vt:6 mL/kg) and group LV+PEEP (Vt:6 mL/kg,PEEP:5 cmH2O). Arterial blood sam-ples were taken and hemodynamic and respiratory variables were recorded before anesthesia induction ( T0 ) ,at 10 min for supine positioning mechanical ventilation after tracheal intubation ( T1 ) ,at 10 min for prone positioning mechanical ventilation after tracheal intubation ( T2 ) ,at 60 min or prone positioning mechanical ventilation after tracheal intubation (T3),and at 30 min after tracheal extubation (T4). Results There was no significant difference in HR,MAP(P>0. 05);Compared with group LV in the same time,mechanical ventilation with group C and group LV+PEEP led to higher airway pressures (Ppeak and Pmean,respectiveiy) (P 0. 05);The Cldyn of mechanical ventilation with group LV and group LV+PEEP was improved compared with group C at the same time ( P0．05)；与LV组同时点比较,C组及LV+PEEP组机械通气期间Ppeak、Pmean较高(P0．05)；LV组及LV+PEEP组Cldyn明显高于同时点C组(P0．05)；在T4时点,LV+PEEP组PaO2/FiO2明显高于C组及LV组,A-aDO2低于C组及LV组,差异有统计学意义(P<0．05)。结论小潮气量联合低水平PEEP(6 mL/kg+5 cmH2 O PEEP)通气能够有效改善全麻俯卧位脊柱手术老年患者术后氧合,提高肺的顺应性,有利于此类手术老年患者呼吸功能的恢复,而且对血流动力学无明显影响。