| Objective:To study two different tide volumes’influence on general anesthesia and mechanically ventilation effectiveness in over weight and o besity patients. A kind of optimistic lung protection ventilation model that could fully oxygenate, avoid hyperventilation and decrease the ventilation-in duced lung injury of occurred risk was exploredMaterial and Method:Conformed to standard 80 patients who would be undergone selective noncardiac surgery were be randomly divided into 4 groups:the male experiment group, the male control group, female e xperiment group and female control group. The control group’s(TCG) tide volume computed value (VTC), VTC= total body weight(TBW)×8ml/kg, the experiment group’s(TEG)VTC, VTC mean body weight index(MBWI)×height(m)2×8 ml/kg. 3μg/ml propofol and 3ng/ml remifentanil were adopte d to in each group patients by target control infusion respectively, during i nduction of anesthesia, with pure oxygen (4L/min) being assisted respiratio n. 0.3 mg/kg atracurium was also infused by vein in each group during i nduction of anesthesia. After tracheal intubation, the actual value of end-ex piratory tidal volume(VTEA) was adjusted to VTC and the rate of mechan ical ventilation Parameters was llbeats/min,With oxygen-air gas mixture 2L /min (the volume of oxygen vs the volume of air equal 1:1), mechanical v entilation was immediately started. VTEA in each patient was recorded. P ropofol (3μg/ml) and remifentanil (3ng/ml) by target control infusion pump also were continuously infused in each patient during maintenance of anes thesia, meanwhile,0.1 mg/kg atracurium was intermittently infused by vein and 1%～2% sevoflurane was also intermittently absorbed to maintain ane sthesia depth.PH, the arterial cardon dioxide pressure (PaCO2), the arterial oxygen pressure(PaO2), fraction of inspiration oxygen (FiO2), base excess (BE) and Air way pressure(PAW) werere respectively recorded at the befor e induction,the mechanical ventilation before, mechanical ventilation start, the post mechanical ventilation 1 hour blood, the end-operation and the res piratory recovery before extubation gas analysis results were recordedResults:TEA in the control group and in the experiment group were compared, P<0.05. VTEA in the male control group was more 20% than VTEA in the male experiment group. VTEA in the female control group was more 13% than VTEA in the female experiment group.PAW at the mechanical ventilation 1h (PAW1h), PAW at at the mecha nical ventilation start and PAW at end-operation (PAWE) in the control gro up and in the experiment group were compared respectively, P<0.05.OGI at the mechanical ventilation 1h (OGIlh), OGIE in the female c ontrol group and in the female experiment group were compared P<0.05. OGIS, OGI1h and OGIE in the male control group and in the male expe OGIS, OGI1h and OGIE in the male control group and in the male expe riment group were compared P>0.05. Patients which oxygenation index (O GI) at end-operation (OGIE) was less than 300 in the female control grou p and those in the female experiment group were 7,1, respectively, P<0.0 5(Fisher’s Exact Test). Patients which (OGIE) was less than 300 in the m ale control group and those in the male experiment group were 8,2,respecti vely, P<0.05. The arterial carbon dioxide pressure at the mechanical ventil ation 1h (PaCO21h) and PaCO2 at end-operation (PaCO2E) in the control gr oup and in the experiment group were compared respectively, P<0.05.Conclusion:Tide volume in the male experiment group is a kind of r elative less tide volume and air way pressure relatively optimistic lung pro tection ventilation model than in the male control group, which could suff iciently maintain lung oxygenated function, avoid hyperventilation and decr ease ventilation-induced lung injury of occurred risk. Tide volume in fem ale experiment group is a kind of relative less tide volume and air way pr essure lung protection optimistic ventilation model than in female control g roup, which could sufficiently improve lung oxygenated function,avoid hy perventilation and decrease ventilation-induced lung injury... |
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