【摘要】 目的 探讨静脉麻醉时行面罩双相气道正压(BiPAP)通气的效果及监测胃内压力的变化。方法 择期行腹腔镜胆囊切除手术的成年患者59例。静脉诱导后用异丙酚-芬太尼-阿曲库铵静脉麻醉维持。Ⅰ组(36例)用Bi-PAP　vision呼吸机行面罩BiPAP通气;Ⅱ组(23例)气管内插管后行机械间歇正压通气。结果 通气后30min两组血压和心率都有所下降(P<0.01),Ⅰ组气腹后30min时血压高于麻醉前测定值(P<0.01),Ⅱ组血压仍低于麻醉前(P<0.01)。机械通气和CO2气腹期间两组SpO2和PaO2都保持较高水平,Ⅰ组PaCO2维持4.6～5.5kPa。两组在气腹期间需较高吸气正压维持有效通气(P<0.01)。麻醉结束后Ⅱ组SpO2和PaO2稍低于麻醉前水平。Ⅰ组气腹后30min时胃内压是气腹前的2.82倍,但麻醉前和清醒后咽部分泌物pH值比较差异无显著性(P>0.05)。结论 静脉麻醉时面罩BiPAP通气能达到机械间歇正压通气的效果。BiPAP通气期间行CO2气腹后胃内压的升高尚未达到反流压力阈值,故静脉麻醉期间行BiPAP无创通气是安全可靠的。更多还原

【Abstract】 Objective To study the effect of bi - phasic positive airway pressure (BiPAP) ventilation with face mask and the possibility of regurgitation in BiPAP ventilation during intravenous anesthesia. Methods 59 patients undergoing laparoscopic cholecys-tectomy were randomly divided into group Ⅰ (36 patients) and group Ⅱ (23 patients) . Propofol- fentanyl- atracurium was administered to maintain intravenous anesthesia after induction. Patients were ventilated by BiPAP vision ventilator with mask in group Ⅰ , and by intermittent positive pressure ventilation( IPPV) after intubation in group Ⅱ . Results In both groups, heart rate and blood pressure (BP) decreased 30 min after ventilation( P < 0.01) . Blood pressure came back to preanesthesia level 30 min after pneumoperitoneum in group Ⅰ (P < 0.01), but BP remained low in group Ⅱ (P < 0.01). SpO2 and PaO2 were normal in both groups. PaCO2 of group Ⅰ ranged from 4.6 to 5.5 kPa during mechanical ventilation. To maintain effective ventilation, the inspiratory positive pressure in both groups was higher in pneumoperitoneum( P < 0.01) . SpO2 and PaO2 of group Ⅱ were lower in extubation than in preanesthesia. In group Ⅰ , the intra - stomach pressure was 2.82 times higher in pneumoperitoneum than in prepneumoperitoneum. There were no significant differences in the pH values of pharyngal secretion between preanesthesia and consciousness recovery (P > 0.05) . Conclusion BiPAP pressure control/support ventilation with face mask can achieve the effect of mechanical intermittent positive pressure volume control ventilation. Increased intra - stomach pressure after pneumoperitoneum dose not exceed the threshold value of regurgitatant pressure during BiPAP ventilation. BiPAP ventilation is reliable during intravenous anesthesia.更多还原