我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

不同的吸入氧浓度对小儿先天性心脏病围术期气体交换的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第3期
页码:
377-380
栏目:
临床研究
出版日期:
2012-06-25

文章信息/Info

Title:
Influence of different types of ventilation on gas exchange in children wih congenital heart disease children during general anesthesia and postoperation
作者:
鞠吉峰1; 2; 3; 刘亚莉2; 乔 彬3; 吴莉莉3; 蒋怡燕3; 师建国1; 裴建明2
(第四军医大学：1.病理学与病理生理学教研室，2.生理学教研室,陕西 西安 710032；3.济南军区总医院心血管病研究所，山东 济南 250022)
Author(s):
JU Ji-feng1; 2; 3;  LIU Ya-li2;  QIAO Bin3;  WU Li-li3;  JIANG Yi-yan3;  SHI Jian-guo1;  PEI Jian-ming2
(1.Department of Pathology and Pathophysiology, 2.Department of Physiology, Fourth Military Medical University, Xi’an 710032, Shaanxi, China; 3.Cardic Institute of Jinan Military General Hospital, Ji’nan 250022, Shandong, China)
关键词:
心脏病; 先天性; 肺不张; 气体交换; 麻醉; 肺分流
Keywords:
congenital heart disease;  atelectasis;  gas exchange;  anesthesia;  pulmonary shunt
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:纯氧常规用于麻醉前预先吸氧和麻醉诱导，但吸高浓度氧会发生肺不张，可在全麻期间损害肺气体交换，本研究以吸入氧浓度（fraction of inspiration oxygen，FiO2）为纯氧(1 L/L)通气为对照，观察气管插管后FiO2为0.5 L/L混合空气通气对气体交换的影响。方法： 先天性心脏病（非紫绀型）手术患者102名，年龄1月～13岁，均以1 L/L O2在麻醉前预先吸氧3 min和（麻醉诱导时）面罩通气2 min，接下来气管插管。这些患者随机分为2组:混合通气组（51例，行FiO2为0.5 L/L O2通气），纯氧通气组（51例，行1 L/L O2通气）。分别于预先吸氧前和气管插管后30 min、入ICU、拔管后30 min以及术后前3 d做动脉血气分析，并计算动脉血氧分压（PaO2）/FiO2比值。结果： PaO2术后在入ICU（0.6 L/L FiO2）、拔管后30 min(1.5 L/min)面罩吸氧两个时间点，动脉血氧PaO2在混合通气组明显高于纯氧通气组，PaO2/FiO2值在插管后30 min、入ICU（0.6 L/L FiO2）、拔管后30 min(1.5 L/min)面罩吸氧等时间点混合通气组明显高于纯氧通气组（P<0.05），且混合通气组的ICU机械通气时间、住留时间及住院时间均明显缩短。结论： 先天性心脏病（非紫绀型）手术患儿全麻时，混合通气较纯氧通气能够显著的改善肺的气体交换功能和预后。
Abstract:
AIM:To evaluate the effect of ventilation with 0.5 L/L FiO2 in air or 1 L/L O2 following intubation on gas exchange. METHODS: One hundred and two patients (aged 1 month to 13 years) undergoing surgical cardiac intervention with congenital heart disease (CHD) (non-cyanosis) were given 1 L/L O2 for preoxygenation (3 min) and ventilation by mask (2 min). Following intubation, patients were randomly divided into two groups (51 patients in each group) and ventilated with either 0.5 L/L FiO2 in air or 1 L/L O2. Arterial blood gases were obtained for analysis before preoxygenation, 30 min following intubation, on entering the ICU, 30 min after extubation and 3 days postoperation. Subsequently, PaO2/FiO2 ratios were calculated. RESULTS: PaO2 values on entering ICU and 30 min after extubation were significantly improved in the group receiving 0.5 L/L FiO2 group than those in the group receiving 1 L/L O2. PaO2/FiO2 ratio in the 0.5 L/L FiO2 group was significantly improved at the following time points: 30 min after intubation, upon entering the ICU and 30 min after extubation. Mechanical ventilation time, time in ICU and length of hospitalization in 0.5 L/L FiO2 group were significantly shortened compared with those in the group receiving 1 L/L O2. CONCLUSION: During general anesthesia in children with CHD (non-cyanosis), ventilation of lungs with 0.5 L/L FiO2 is superior for improving gas exchange than ventilation of lungs with 1 L/L O2.

参考文献/References

[1]Bendixen HH,Hedley Whyte J,Laver MB.Impaired oxygenation in surgical patients during general anesthe-sia with controlled ventilation: A concept of atelectasis[J].N Engl J Med,1963,269(7):991-996.

[2]Brismar B,Hedenstierna G,Lundquist H,et al.Pulmonary densities during anes-thesia with muscular relaxation: a proposal of atelectasis[J].Anesthesiology,1985,62(4):422-428.

[3]Gunnarsson L,Tokics L,Gustavsson H,et al.Influence of age on atelectasis formation and gas exchange impairment during general anesthesia[J].Br J Anaesth,1991,66(4):423-443.

[4]David M,Karmrodt J,Bletz C,et al.Analysis of atelectasis, ventilated, and hyperinflated lung during mechanical ventilation by dynamic CT[J].Chest,2005,128(5):3757-3770.

[5]Rothen HU,Sporre B,Engberg G,et al.Prevention of atelectasis during general anaesthesia[J].Lancer,1995,345(3):1387-1391.

[6]Wahba RWM.Perioperative functional residual capacity[J].Can J Anaesth,1991,38(3):384-400.

[7]Rothen HU,Sporre B,Engberg G,et al.Airway closure,atelectasis and gas exchange during general anaesthesia[J].Br J Anaesth,1998,81(5):681-686.

[8]Whiteley JP,Gavaghan DJ,Hahn CEW,et al.Variation of venous admixture,SF6 shunt,PaO2,and the PaO2/FiO2 ratio with FiO2[J].Br J Anaesth,2002,88(6):771-778.

[9] Agarwal A,Singh PK,Dhiraj S,et al.Oxygen in air (FiO2 0.4)improves gas exchange in young healthy patients during general anesthesia[J].Can J Anaesth,2002,49(10):1040-1043.

[10]Neumann P,Rothen HU,Berglund JE,et al.Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration[J].Acta Anaesthiol Scand,1999,43(1):295-301.

[11]Rothen HU,Sporre B,Engberg G,et al.Re-expansion of atelectasis during general anaesthesia:a computed tomograph study[J].Br J Anaesth,1993,71(6):788-795.

[12]刘 健,宁岩松,王同健.婴儿先天性心脏病术后肺不张的原因分析及处理[J].实用医药杂志, 2006,23(1):61-62.

[13]Hedenstierna G,Rothen HU.Atelectasis formation during anesthesia:causes and measures to prevent it[J].J Clin Monit Comput,2000,16(5-6):329-335.

备注/Memo

备注/Memo:
收稿日期：2011-12-15.通讯作者：裴建明，教授，主要从事心血管生理学研究Email:jmpei8@fmmu.edu.cn 共同通讯作者：师建国，教授，主要从事病理学研究 Email:shijg2000@yahoo.com.cn 作者简介：鞠吉峰，副主任医师，硕士生 Email:jujifeng777@sina.com
更新日期/Last Update: 2012-05-02