【摘要】 目的研究呼气末正压(positive end-expiratory pressure,PEEP)对截石位开腹手术的全麻患者肺泡氧合功能的影响。方法选择40例采取截石位行开腹肠道手术的患者,随机分为A组(PEEP=0 cmH2O,n=20)和B组(PEEP=10 cmH2O,n=20);另选20例采取仰卧位行开腹肠道手术的患者作为对照组C组。所有患者均采用气管内插管全身麻醉、机械通气。比较3组患者在不同时点的动脉血氧分压(PaO2)和肺泡-动脉血氧分压差[P(A-a)DO2)]的变化。结果与C组相比,A组和B组在摆放体位后30 min PaO2出现下降,两组的氧分压变化百分比和肺泡-动脉氧分压差百分比与C组相比差异都具有显著统计学意义(P=0.00)。与A组相比,B组在加用10 cmH2O的PEEP后60 min,PaO2明显上升、P(A-a)DO2显著下降。结论截石位在一定程度上影响患者的肺泡氧合,而逐级上调PEEP值至10 cmH2O可以在不影响循环稳定的同时改善肺泡氧合功能。更多还原

【Abstract】 Objective To evaluate the effects of positive end-expiratory pressure(PEEP)on alveolar oxygenation in patients undergoing laparotomy with lithotomy position.Methods A total of 40 patients accepting laparotomy with lithotomy position were ramdomly divided into two equal groups:group A(PEEP=0 cmH2O,n=20) and group B(PEEP=10 cmH2O,n=20).Another 20 patients accepting laparotomy with supine position served as the control group.All patients received general anesthesia with tracheal intubation and mechanical ventilation.Blood gas analysis was taken at multiple points of time,and the change of the arterial partial pressure(PaO2) and alveolar-arterial oxygen pressure difference [P(A-a) DO2] were compared.Results Compared with group C,both group A and B showed significant decrease of PaO2 after 30 minutes of being placed in the lithotomy position.Compared with group A,the PaO2 in the group B increased significantly while the P(A-a) DO2 decreased after 60 minutes of the ventilation strategy.Conclusions The lithotomy position could adversely affect the alveolar oxygenation of patients undergoing laparotomy.Incremental PEEP remarkably improves the alveolar oxygenation without affecting the stability of circulation.更多还原