贵州医科大学学报

2020, v.45;No.235(04) 472-476

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不同BMI学龄期患儿行四肢手术插管全麻期间的血气参数及呼吸参数特点分析
Characteristics of Respiratory Parameters during Intubation of General Anesthesia in Limb Surgery among School-Age Children with Different BMI

李玲霞;苏鸿莉;胡彬;王敏;
LI Lingxia;SU Hongli;HU Bin;WANG Min;Department of Anesthesiology,The Affiliated Hospital of Yan'an University;

摘要(Abstract):

目的:分析不同体质量指数(BMI)学龄期患儿行四肢手术插管全麻期间的血气参数、呼吸参数及不良反应。方法:206例外科全麻下行四肢手术的学龄期患儿,根据BMI分为消瘦组(15~18 kg/m~2)、正常组(18~23 kg/m~2)及超重组(>23 kg/m~2);分别于潮气量调整稳定后10、30及60 min时,记录3组患儿的血气参数[动脉血p H值、动脉血氧分压(Pa O_2)、动脉血二氧化碳分压(Pa CO_2)]及呼吸参数[吸入潮气量(VTi)、呼出潮气量(VTe)、呼气末二氧化碳分压(P_(ET)CO_2)、气道峰压(P_(peak))、气道平台压(P_(plat))、肺动态顺应性(Cdyn)];比较3组患儿术后48 h内出现的胃肠胀气、咽部不适和呛咳等不良反应发生率。结果:通气后各时点,3组患儿不同时点的p H、动脉血Pa O_2比较,差异无统计学意义(P> 0. 05);同组患儿在3个时间点的VTi、VTe、P_(peak)、P_(plat)、P_(ET) CO_2及Cdyn比较,差异无统计学意义(P>0. 05);超重组患儿各时点的Pa CO_2低于同时点正常组和消瘦组,差异有统计学意义(P <0. 05);在同一时间点,VTi、VTe及Cdyn比较,消瘦组>正常组>超重组,P_(peak)、P_(plat)和P_(ET) CO_2比较,消瘦组<正常组<超重组,差异有统计学意义(P <0. 05);术后48 h内,3组患儿不良反应发生率比较,超重组>消瘦组>正常组,差异有统计学意义(P <0. 05)。结论:不同BMI的学龄期患儿行四肢手术插管全麻期间的血气参数、呼吸参数及不良反应存在差异,在插管全麻中设置潮气量应参考BMI参数进行调整。
Objective: To analyze the blood gas parameters,respiratory parameters and adverse reactions during intubation of general anesthesia for school-aged children with limb surgery under different body mass index( BMI). Methods: A total of 206 children with general anesthesia and extremity surgery were divided into the lean group( 15 ~ 18 kg/m~2),the normal group( 18 ~ 23 kg/m~2) and the overweight group( > 23 kg/m~2) according to BMI. The differences in the blood gas parameters,respiratory parameters,and adverse reactions among the groups were compared. Results:There was no significant difference in gender,age,height and operation time among the three groups( P >0. 05). The BMI and weight of the lean group were lower than that of the normal group,and the BMI and weight of the overweight group were higher than that of the normal group( P < 0. 05). There was no significant difference in arterial blood pH,PaCO_2 and PaO_2 10 minutes,30 minutes and 60 minutes after ventilation( P > 0. 05),and no significant difference was found in arterial blood pH and PaO_2 among the three groups( P > 0. 05). PaCO_2 of the overweight group was lower than that of the lean and normal groups,and the difference was statistically significant( P < 0. 05). There was no significant difference in VTi,VTe,P_(peak),P_(plat),P_(ET)CO_2 and Cdyn at the 3 time points( P > 0. 05),while VTi,VTe,and Cdyn of the lean group were higher than those of the normal group,and VTi,VTe,and Cdyn of the overweight group were lower than those of the normal group,and the difference was statistically significant( P < 0. 05). P_(peak),P_(plat)and P_(ET)CO_2 of the lean group were lower than those of the normal group,while P_(peak),P_(plat)and P_(ET)CO_2 of the overweight group were higher than that of the normal group,and the difference was statistically significant( P < 0. 05). The incidence of flatulence,pharyngeal discomfort and cough in the lean and overweight groups were higher than those in the normal group( P < 0. 05). Conclusion: The tidal volume of the lean group was higher than that of the normal group,and the tidal volume of the overweight group was lower than that of the normal group.The tidal volume in the general anesthesia should be adjusted according to the BMI.

关键词(KeyWords): 人体质量指数;插管全麻;呼吸参数;血气参数;学龄期
body mass index(BMI);intubation general anesthesia;respiratory parameters;blood gas parameters;school-aged

Abstract:

Keywords:

基金项目(Foundation): 陕西省社会发展科技攻关项目(2016SF-075);; 延安市科学技术局科技攻关计划项目(2018KS-10)

作者(Author): 李玲霞;苏鸿莉;胡彬;王敏;
LI Lingxia;SU Hongli;HU Bin;WANG Min;Department of Anesthesiology,The Affiliated Hospital of Yan'an University;

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DOI: 10.19367/j.cnki.1000-2707.2020.04.018

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