小潮气量快频率压力控制通气模式在婴儿胸腔镜手术中的应用

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摘要目的探讨小潮气量快频率压力控制通气模式在婴儿胸腔镜手术中的应用，为不能实现单肺通气的婴儿胸腔镜手术提供一种可行的通气方法。方法选取2016年12月—2019年8月首都医科大学附属北京儿童医院择期行胸腔镜手术患儿19例为研究对象。麻醉诱导后行单腔管主气管内插管，呼吸频率（RR）为24~34次/min，吸呼比（I∶E）为1∶1.5，潮气量维持在9~10 mL/kg。建立人工气胸后调整通气模式为小潮气量快频率压力控制通气，RR为30~40次/min，I∶E为1∶1，潮气量维持在6~7 mL/kg。记录并观察患儿小潮气量快频率通气前（Ta）、小潮气量快频率通气10 min（T10）、小潮气量快频率通气30 min（T30）、恢复正常双肺通气10 min后（Tz）心率（HR）、经皮脉搏血氧饱和度（SpO2）、平均动脉压（MAP）、RR、气道峰压（PPEAK）、呼气末二氧化碳分压（PETCO2）。记录麻醉相关并发症发生情况。结果 T10、T30 HR、RR、PPEAK、PETCO2水平高于Ta，SpO2、MAP水平低于Ta（均P < 0.05）；T30 HR、PETCO2水平低于T10，SpO2、MAP、RR水平高于T10（均P < 0.05）；Tz HR、RR、PPEAK、PETCO2水平低于T10、T30，SpO2、MAP水平高于T10、T30（均P < 0.05）；Tz PPEAK、PETCO2水平高于Ta（均P < 0.05）。拔管后均无声音嘶哑、肺不张等麻醉相关并发症发生。结论对于婴儿胸腔镜手术中不能实现单肺通气的情况，应用小潮气量快频率压力控制通气模式是一种可行的方法。

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	邹楠张建敏辛忠▲

关键词 ：潮气量, 快频率, 压力控制, 婴儿, 胸腔镜

Abstract：Objective To investigate the application of high frequency with low tidal volume by pressure controlled ventilation mode in thoracoscopic surgery for infants, and to provide a feasible ventilation method for infants who cannot achieve one lung ventilation in thoracoscopic surgery. Methods Nineteen infants who received thoracoscopic surgery in Beijing Children′s Hospital, Capital Medical University from December 2016 to August 2019 were selected as study objects. Single lumen main endotracheal intubation was performed after induction of anesthesia. The respiratory rate (RR) was 24-34 times/min, the inspiration/exhalation ratio (I∶E) was 1∶1.5, and the tidal volume was maintained at 9-10 mL/kg. After the establishment of artificial pneumothorax, used high frequency with low tidal volume by pressure controlled ventilation mode, RR was 30-40 times/min, I∶E was 1∶1, and the tidal volume was maintained at 6-7 mL/kg. Heart rate (HR), percutaneous pulse oxygen saturation (SpO2), mean arterial pressure (MAP), RR, the airway peak pressure (PPEAK), and end-expiratory partial carbon dioxide (PETCO2) were observed and recorded at before used high frequency with low tidal volume by pressure controlled ventilation mode (Ta), 10 min after used high frequency with low tidal volume by pressure controlled ventilation mode (T10), 30 min after used high frequency with low tidal volume by pressure controlled ventilation mode (T30) and bilateral ventilation was restored 10 min (Tz). Anaesthesia related complications were recorded. Results HR, RR, PPEAK and PETCO2 levels at T10, T30 were higher than those at Ta, SpO2 and MAP levels were lower than those at Ta (all P < 0.05). HR and PETCO2 levels at T30 were lower than those at T10, while SpO2, MAP and RR levels were higher than those at T10 (all P < 0.05). HR, RR, PPEAK and PETCO2 levels at Tz were lower than those at T10 and T30, SpO2 and MAP levels were higher than those at T10 and T30 (all P < 0.05). PPEAK and PETCO2 levels at Tz were higher than those at Ta (all P < 0.05). There were no complications related to anesthesia such as hoarseness and atelectasis occurred after extubation. Conclusion For infants who cannot achieve one lung ventilation in thoracoscopic surgery, the application of high frequency with low tidal volume by pressure controlled ventilation mode is a feasible method.

Key words： Tidal volume High frequency Pressure control Infant Thoracoscope

通讯作者: ▲通讯作者

引用本文:

邹楠张建敏辛忠▲. 小潮气量快频率压力控制通气模式在婴儿胸腔镜手术中的应用[J]. 中国医药导报, 2020, 17(25): 115-118.
ZOU Nan ZHANG Jianmin XIN Zhong▲. Application of high frequency with low tidal volume by pressure controlled ventilation mode in infant thoracoscopic surgery. 中国医药导报, 2020, 17(25): 115-118.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I25/115

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