呼气末正压通气在全麻下经皮肾镜碎石术中对患者呼吸功能的影响

目的探讨全麻下经皮肾镜碎石术（PcNL）灌注碎石期间应用呼气末正压通气（PEEP）对患者呼吸功能的影响。方法选择全身麻醉经皮肾镜碎石术的患者60例（ASAⅠ～Ⅱ级），随机分成两组，每组30例，潮气量设定8ml／kg。对照组（A组）PEEP0cmH20，研究组（B组）PEEP5cmHzO。麻醉诱导后监测无创血压（BP）、平均动脉压（MAP）、心率（HR）、血氧饱和度（Sp02）、中心静脉压（CVP）、气道压力（Pmean）;患者俯卧位后，选灌注碎石术前（T1）、灌注碎石30min（T2）、灌注碎石60rain（T3）和灌注完毕即时（T4）为时间点，检测动脉血气（pH、PaCOz、Pa02、BE）。结果两组比较，B组的PaOz、CVP、Pmean值明显增加，差异有统计学意义（P〈0．05）；而HR、MAP值比较无统计学意义（P〉0．05）。两组组内与T1时点比较，T2～T4时点的pH、BE、Pa02值明显下降，PaCOz、CVP、Pmean值有所增高，差异有统计学意义（P〈0．05）。结论在全麻下经皮肾镜碎石术（PCNL）中应用PEEP辅助通气，动脉血氧分压升高，可有效改善动脉氧合，气道压力和CVP水平有相应升高，术中应加强CVP及动脉血气的监测。

The effects of positive end-expiratory pressure (PEEP) on respiratory fuction in the patients undergoing Percutaneous Nephrolithotomy (PCNL)

Objective To explore the effects of positive endexpiratory pressure（PEEP） on central venous pres- sure,airway pressure and blood gas in the patients undergoing percutaneous nephrolithotomy（PCNL）. Methods Sixty patients with upper urinary calculi, anesthesia ASA grading Ⅰ -Ⅱ. Undergoing PCNL in the prone posi- tion under general anesthesia. These patients were randomly assigned into 2 groups, group A （control group, n = 30） PEEP 0 cmH2O,group B （PEEP group,n= 30） PEEP 5 cmH2O. To observation noninvasive blood pressure （BP）, mean arterial pressure （MAP）, heart rate （HR）, oxygen saturation （SpO2）, central venous pressure （CVP）, airway pressure （Prnean）. After patients were prone position, for the recording time points： before lithotripsy （T1） ,started lithotripsy 30 min （T2）,started lithotripsy 60 rain （T3）,finished lithotripsy （T4）,to record arterial blood gas values of pH （pH） ,partial pressure of carbon dioxide （PaCO2） ,partial pressure of oxygen （PaOz） ,base excess（BE）. Results Compared with group A（PEEP 0 cmH2O）,after group B was given PEEP 5 cmH2O,the level of CVP,pmean and PaO2 of group B was significantly higher than that of group A （P〈0. 05）, MAP, HR, pH, PaCO2, and BE between two groups were not different（P〉0.05）. Compared with T1, following the promo- tion of operation,in T2- T4, the levels of p H , BE, PaO2 were lower than those of TI（P〈0. 05）, CVP and Pmean of T2~T4 were significantly higher than that of group B（P〈0. 05）. Conclusion The patients undergoing PC- NL in general anesthesia, with PEEP, PaO2 and arterial oxygenation can be improved effectively, airway pressure and the level of CVP increase during the PCNL,so that anesthesiologists should strengthen the monitoring.