全麻诱导时不同压力控制面罩通气对胃胀气影响

梅玫; 张从利; 张颖; 程向阳

doi:10.13898/j.cnki.issn.1000-2200.2021.11.009

全麻诱导时不同压力控制面罩通气对胃胀气影响

Effect of different pressure control mask ventilation on gastric distension during the induction of general anesthesia

摘要

摘要:
目的评价全麻诱导时不同压力控制面罩通气对胃胀气影响。
方法选择择期行腹腔镜下全子宫切除术病人45例，根据通气压力值不同分为P10组、P15组和P20组，各15例，面罩通气时分别给予10、15、20 cmH₂O压力。于麻醉诱导前（T0）和扣紧面罩通气30 s（T1）、60 s（T2）、90 s（T3）、120 s（T4）时记录病人血氧饱和度（SpO₂）及潮气量，记录喉罩置入后即刻（T5）病人呼吸末二氧化碳分压（P_ETCO₂）；记录手术开始时腔镜下胃形态分级，并于T0和T5时采用超声测量病人胃窦前后轴径及左右轴径，计算胃窦部横截面积（CSA）及胃胀气百分比。
结果除P20组1例病人喉罩漏气未纳入统计外，其余病人均完成研究。T0时3组病人胃窦部CSA差异无统计学意义（P>0.05）；T5时P20组CSA差值均高于P10组和P15组（P < 0.05），P15组亦高于P10组（P < 0.05）。3组病人胃胀气百分比和胃形态分级间差异均有统计学意义（P < 0.05）。T5时P20组P_ETCO₂均低于P10组和P15组（P < 0.05），P15组亦低于P10组（P < 0.05）。T0时3组病人SpO₂差异无统计学意义（P>0.05）；T1~T4时，P15和P20组SpO₂均高于P10组（P < 0.05），T2和T3时，P20组SpO₂亦均高于P15组（P < 0.05）。T1~T4时，P20组潮气量均高于P10组和P15组（P < 0.05），P15组亦均高于P10组（P < 0.05）。
结论腹腔镜下全子宫切除术时，面罩通气采用10~15 cmH₂O压力模式通气，可在保证病人肺通气充足情况下减少胃胀气；且超声测胃窦面积评价胃胀气具有一定可行性。

Abstract:
ObjectiveTo evaluate the effects of different pressure control mask ventilation on gastric distension during the induction of general anesthesia.
MethodsForty-five patients scheduled by laparoscopic total hysterectomy were divided into the P10 group, P15 group and P20 group according to different ventilation pressure(15 cases in each group).The P10 group, P15 group and P20 group were given 10, 15 and 20 cmH₂O pressure during mask ventilation, respectively.The SpO₂ and tidal volume were recorded before anesthesia induction(T0), and at 30 s(T1), 60 s(T2), 90 s(T3) and 120 s(T4) of the locking mask ventilation, and the P_ETCO₂ was recorded immediately after laryngeal mask placement(T5).The endoscopic grading of gastric morphology was recorded at the beginning of surgery.At T0 and T5, the anterior-posterior axis diameter and left-right axis diameter of gastric antrum were measured by ultrasound, and the cross-sectional area(CSA) of gastric antrum and the percentage of gastric distension were calculated.
ResultsAll patients completed the study except 1 patient with laryngeal mask leakage in P20 group.At T0, there was no statistical significance in the gastric antrum CSA among three groups(P>0.05).At T5, the difference of CSA in P20 group was higher than that in P10 group and P15 group(P < 0.05), and which in P15 group was higher than that in P10 group(P < 0.05).At T0, the differences of the percentage of flatulence and grading of stomach morphology among three groups were statistically significant(P < 0.05).At T5, the P_ETCO₂ in P20 group was lower than that in P10 group and P15 group(P < 0.05), and which in P15 group was lower than that in P10 group(P < 0.05).At T0, the differences of the SpO₂ among three groups were not statistically significant(P>0.05).From T1 to T4, the SpO₂ in P15 group and P20 group was higher than that in P10 group(P < 0.05).At T2 and T3, the SpO₂ in P20 group was higher than that in P15 group(P < 0.05).From T1 to T4, the tidal volume in P20 group was higher than that in P10 group and P15 group(P < 0.05), and which in P15 group was also higher than that in P10 group(P < 0.05).
ConclusionsDuring the laparoscopic total hysterectomy, the mask ventilation with 10-15 cmH₂O pressure mode can reduce the gastric distention while ensuring adequate lung ventilation.The ultrasonographic measurement of gastric antrum area is feasible to evaluate gastric distension.

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