李玲霞,苏鸿莉,胡彬,王敏
LI Lingxia,SU Hongli,HU Bin,WANG Min

• 1:延安大学附属医院麻醉科

摘要(Abstract)：

目的:探讨校正体质量测算潮气量在四肢手术消瘦患儿插管全麻术中的应用效果。方法:100例行全麻下行四肢手术、体质量指数(BMI)15～18 kg/m~2的消瘦患儿均分为对照组和观察组,对照组患儿采用实际体质量测算潮气量,观察组患儿采用校正体质量测算潮气量(校正体质量乘以8 mL/kg测算);比较2组患儿机械通气开始后10 min时的气道峰压(P_(peak))、气道平台压(P_(plat))、气道阻力(Raw)、呼气末二氧化碳(PetCO_2)、平均动脉压(MAP)及心率(HR),比较机械通气后30 min时的动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)、氧合指数(OI)及潮气量,比较治疗结束时的肌肉神经血管损伤患儿比例、机械通气及住院时间。结果:机械通气后30 min时,观察组患儿的潮气量显著高于对照组、PaCO_2及PetCO_2均显著低于对照组(P<0.01),2组患儿的PaO_2及OI比较,差异均无统计学意义(P>0.05);机械通气开始10 min时观察组患儿P_(peak)、P_(plat)、Raw显著高于对照组(P<0.01),2组患儿MAP及HR比较,差异无统计学意义(P>0.05);治疗结束时,对照组2例患儿出现肌肉神经血管损伤,观察组患儿的机械通气时间及住院时间均显著低于对照组(P<0.01)。结论:对于BMI15～18 kg/m~2的消瘦患儿,推荐按照校正体质量乘以8 mL/kg测算潮气量应用于插管全麻四肢手术中。
Objective: To discuss the effect of corrected body mass measurement of tidal volume on intubation and general anesthesia in children undergoing four-limb surgery. Methods: 100 cases with body mass index(BMI) of 15～18 kg/m~2 were divided into control group and observation group. In the control group, the volume of the actual body was used to measure the tidal volume, and The tidal volume was measured by corrected body mass in the observation group(the mass of the correction body multiplied by 8 mL/kg). The peak airway pressure(P_(peak)), airway platform pressure(P_(plat)), airway resistance(Raw), end-exhalation carbon dioxide(PetCO_2), mean arterial pressure(MAP) and heart rate(HR) were compared between the two groups at 10 min after mechanical ventilation. The partial pressure of carbon dioxide in artery(PaCO_2), arterial oxygen partial pressure(PaO_2), oxygenation index(OI) and tidal volume were compared at 30 min after mechanical ventilation. Proportion of children with neurovascular injury at the end of treatment, mechanical ventilation and hospital stay were compared. Results: At 30 min after mechanical ventilation, the tidal volume of the children in the observation group was significantly higher than that in the control group, while PaCO_2 and PetCO_2 were significantly lower than those in the control group(P<0.01).The difference of PaO_2 and OI in two groups was not statistically significant(P>0.05). P_(peak), P_(plat) and Raw in the observation group were significantly higher than those in the control group at the start of mechanical ventilation for 10 min(P<0.01). The difference of MAP and HR in two groups was not statistically significant(P>0.05). At the end of the treatment, 2 children in the control group experienced muscle neurovascular injury, and the mechanical ventilation time and the hospitalization time of the children in the observation group were significantly lower than that of the control group(P<0.01). Conclusion: For children with BMI at 15～18 kg/m~2, it is recommended to measure the tidal volume by multiplying body mass by 8 mL/kg to be used in the operation of limbs of intubation general anesthesia.

关键词(KeyWords)： 体质量;校正;潮气量;机械通气;插管全麻;患儿,消瘦;血气分析
body mass;correction;tidal volume;mechanical ventilation;general anesthesia for intubation;children,emaciation;blood gas analysis

Abstract:

Keywords:

基金项目(Foundation): 陕西省社会发展科技攻关项目(2016SF-075)

作者(Author): 李玲霞,苏鸿莉,胡彬,王敏
LI Lingxia,SU Hongli,HU Bin,WANG Min

DOI: 10.19367/j.cnki.1000-2707.2019.12.021

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