【摘要】：目的： 麻醉手術(shù)過程中,需要為患者設(shè)置一個(gè)合理的潮氣量,傳統(tǒng)上是按照8ml/kg實(shí)際體重計(jì)算潮氣量,呼吸頻率為15次/min。但是隨著生活水平的提高,人們體重超重和肥胖的發(fā)生率也在逐步升高。如果我們根據(jù)目前的測(cè)算潮氣量方法設(shè)置潮氣量,那么這樣的潮氣量對(duì)于體重超標(biāo)的人群是否合適?在臨床工作中我們發(fā)現(xiàn)肥胖患者采用該潮氣量機(jī)械通氣時(shí)存在不同程度的過度通氣。有學(xué)者提出用理想體重來計(jì)算潮氣量,在臨床應(yīng)用中發(fā)現(xiàn)其對(duì)于肥胖患者偏差也較大。因此,我們根據(jù)預(yù)實(shí)驗(yàn)結(jié)果提出以理想體重加超標(biāo)體重的30%做為校正體重,同時(shí)嘗試根據(jù)理想體重、校正體重和實(shí)際體重來測(cè)算潮氣量,對(duì)比其氧合及二氧化碳排出情況,并檢測(cè)是否有呼吸機(jī)相關(guān)的肺損傷,以探討適合肥胖患者的潮氣量測(cè)算方法。方法： 擇期行四肢手術(shù)的肥胖患者60例,均為平臥位手術(shù),ASA Ⅰ～Ⅱ級(jí),隨機(jī)分成3組,每組20例,分別按8ml/kg理想體重(IBW組)、校正體重(CBW組)和實(shí)際體重(ABW組)設(shè)置初始潮氣量,呼吸頻率為15次/min。校正體重為理想體重加超標(biāo)體重的30%,理想體重計(jì)算公式應(yīng)用的是我國(guó)常用的Broca改良式：男性為理想體重(kg)=身高(cm)-105；女性為理想體重(kg)=身高(cm)-105-2.5。機(jī)械通氣開始后10min觀察記錄氣道峰壓(Ppeak)、氣道平臺(tái)壓(Pplat)和氣道阻力(Raw)；于機(jī)械通氣后30min抽動(dòng)脈血測(cè)血?dú)夥治?記錄動(dòng)脈血二氧化碳分壓(PaCO2),并對(duì)PaCO245mmHg或35mmHg的患者重新調(diào)整潮氣量,記錄各組需要調(diào)整潮氣量的患者例數(shù),記錄動(dòng)脈血氧分壓(Pa02)并計(jì)算氧合指數(shù)(OI)；于機(jī)械通氣后1h抽動(dòng)脈血3ml,ELISA法測(cè)定血清中IL-6和IL-8濃度。 結(jié)果： 按照三種不同方法計(jì)算潮氣量進(jìn)行機(jī)械通氣后Pa02和OI無明顯差異(P0.05),均能提供很好的氧合。與CBW組相比,IBW組PaCO2明顯升高(P0.01), ABW組PaCO2明顯降低(P＜0.01);IBW組和ABW組需要調(diào)整呼吸參數(shù)的患者例數(shù)(16/20和19/20)與CBW組(0/20)相比明顯增加(P0.01)；與CBW組相比,ABW組Ppeak、Pplat、Raw明顯升高(P0.01)；與CBW組相比,ABW組IL-6和IL-8濃度明顯升高(P0.01)。 結(jié)論： 對(duì)于肺功能正常的肥胖患者,將呼吸頻率設(shè)為15次/min時(shí),按校正體重(理想體重加超標(biāo)體重的30%)以8ml/kg設(shè)置初始潮氣量較為合適,能維持良好的氧合和二氧化碳的排出,減少機(jī)械通氣引起的肺損傷,降低再次調(diào)整呼吸參數(shù)的比例。
[Abstract]:Objective: during anaesthesia operation, it is necessary to set up a reasonable tidal volume for the patient. Traditionally, the tidal volume is calculated according to the actual weight of 8ml/kg, and the respiratory frequency is 15 times / min.. But with rising living standards, the incidence of overweight and obesity is increasing. If we set up a tidal volume based on the current method of measuring moisture, is it appropriate for people who are overweight? In clinical work, we found that obese patients had different degrees of hyperventilation when using the tidal volume mechanical ventilation. Some scholars have suggested that the ideal weight should be used to calculate the moisture volume, and it is found that there is also a large deviation for obese patients in clinical application. Therefore, based on the results of the pre-experiment, we propose to take the ideal weight plus 30% of the excess body weight as the corrected weight, and at the same time we try to calculate the moisture volume according to the ideal weight, the corrected weight and the actual weight, and compare the oxygen and carbon dioxide emissions. To investigate the method of measuring tidal volume for obese patients, and to detect ventilator-related lung injury. Methods: sixty patients with obesity underwent elective limb surgery were divided into 3 groups randomly, 20 cases in each group according to the ideal weight of 8ml/kg (IBW group). All patients were operated on in supine position. The patients were divided into 3 groups (ASA 鈪，

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