[1]李玲霞,高东梅,胡 彬,等.校正体重与学龄期肥胖患儿全麻机械通气潮气量相关性研究*[J].陕西医学杂志,2019,(9):1138-1140，1146.
　LI Lingxia,GAO Dongmei,HU Bin,et al.Adjustment for correlation between body weight and tide volume 〖JZ〗of mechanical ventilation in children with schoolage obesity[J].,2019,(9):1138-1140，1146.
点击复制

校正体重与学龄期肥胖患儿全麻机械通气潮气量相关性研究*
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年9期
页码:
1138-1140，1146
栏目:
临床研究
出版日期:
2019-09-05

文章信息/Info

Title:
Adjustment for correlation between body weight and tide volume 〖JZ〗of mechanical ventilation in children with schoolage obesity
文章编号:
DOI:〖HT5K〗10.3969/j.issn.10007377.2019.09.009
作者:
李玲霞1; 高东梅2; 胡 彬1; 代玲杰1
1.延安大学附属医院麻醉科（延安716000）；2.延安大学附属医院疼痛康复中心（延安716000）
Author(s):
LI Lingxia; GAO Dongmei; HU Bin; et al.
Department of Anesthesiology，Yan’an University Hospital(Yan’an 716000)
关键词:
肥胖儿童; 实际体重; 理想体重; 校正体重; 潮气量; 全身麻醉
Keywords:
Key words 〖WT5BZ〗〖HT5”SS〗〖JP2〗obese children; Actual weight; Ideal weight; Weight adjustment; Tidal volume; General anaesthesia
分类号:
R737.31
文献标志码:
A
摘要:
摘 要 〖HT5K〗目的：探讨肥胖儿童患者全身麻醉机械通气时根据校正体重设置潮气量大小的可行性。方法:选择行四肢手术的8~12岁肥胖儿童患者150例，均为仰卧位手术，ASA Ⅰ~Ⅱ级；将其随机分成实际体重组（ABW）、理想体重组（IBW）和校正体重组（CBW）三组 各50例，分别按10 ml/kg设置三组潮气量大小，呼吸频率为16次/min；观察并记录机械通气25min后三组患儿潮气量、PETCO2、气道平台压、气道峰压等，并抽动脉血进行血气分析，比较PaCO2、PaO2、氧合指数，并对PaCO2＜ 35mmHg或＞ 45 mmHg的肥胖儿童患者重新调整潮气量，记录每组需要调整潮气量的人数。结果:机械通气25min后，与校正体重组相比，实际体重组潮气量较大，理想体重组潮气量较小,两组比较有统计学差异（P＜0.05）；实际体重组PETCO2较校正体重组小，理想体重组PETCO2较校正组大，两组比较有统计学差异（P＜0.05）；与校正体重组相比，实际体重组气道平台压、气道峰压明显升高，两组比较有统计学差异（P＜0.05）；与校正体重组相比，实际体重组患者PaO2和氧合指数无统计学差异(P＞0.05)，均能提供良好的氧合，，差异无统计学意义；实际体重组和理想体重组需要调整潮气量大小的的患儿例数（44/50、42/50）与校正体重组（1/50）相比明显增加，差异有统计学意义（P＜0.05）。结论：对于肺功能正常的学龄期肥胖儿童患者，将呼吸频率设为16次/min时，使用校正体重组以10 ml/kg设置初始潮气量较为合适，能维持较好的氧合和CO2的排出，降低再次调整呼吸参数的比例。
Abstract:
Abstract 〖WT5BZ〗〖HT5”SS〗objective：to explore the feasibility of setting tidal volume according to correct body weight during mechanical ventilation under general anesthesia in obese children. Methods：select limbs operation is 8 to 12 years old obese children，150 cases of patients，all is supine surgery，ASAⅠ  Ⅱ level，who will be randomly divided into the actual body weight (ABW)，ideal body weight group (IBW) and Corrected body weight (CBW) three groups，each 50 cases；The tidal volume of the three groups was set at 10 mLp，and the breathing rate was 16 times /min. Tidal volume，PETCO2，airway platform pressure，and airway peak pressure were observed and recorded in the three groups after 25min of mechanical ventilation. Arterial blood was taken for blood gas analysis，and PaCO2，PaO2，and oxygenation index were compared. The tidal volume of obese children with PaCO2 ＜ 35mmHg or ＞ 45mmhg was readjusted，and the number of children in each group who needed to adjust tidal volume was recorded. Results：after 25min of mechanical ventilation，the tidal volume in the actual weight group was larger than that in the ideal body weight group，and the tidal volume in the ideal body weight group was smaller than that in the corrected body weight group (P＜0.05). The difference between the two groups was statistically significant. PETCO2 in the actual weight group was smaller than that in the correction group，while PETCO2 in the ideal weight group was larger than that in the correction group，P＜0.05. Compared with the body alignment recombination，the airway platform pressure and peak pressure in the actual body weight group were significantly increased (P＜0.05)，indicating a significant difference between the two groups. There was no significant difference in Pa02 and oxygenation index between the three groups of patients，all of which provided good oxygenation (P＞0.05，no statistical significance). The number of ca〖LM〗ses (44/50，42/50) of children in the actual weight group and the ideal weight group who needed to adjust tidal volume was significantly higher than that in the normal body restructuring (1/50)，and the difference was statistically significant (P＜0.05). Conclusion：for schoolage obese children with normal lung function，when the respiratory frequency is set to 16 times /min，it is more appropriate to set the initial tidal volume at 10 MLP by rightbody restructuring，which can maintain good oxygenation and CO2 emission，and reduce the proportion of readjusting respiratory parameters.

参考文献/References:

[1] 〖ZK（#〗王存川,张 鹏,杨景哥,等.中国儿童和青少年肥胖症外科治疗指南(2019版)[J] .中华肥胖与代谢病电子杂志,2019,5(1):39.〖ZK)〗〖HT〗〖JY〗(下转第1146页)〖FL)〗
[2] 〖ZK（#〗马冠生.中国儿童肥胖报告[M].北京:人民卫生出版社，2017:529.
[3] 钱小慧,陆如纲.我国儿童日间手术发展现状分析[J] .江苏卫生事业管理,2018,29(6):652654.
[4] 马可泽,赖志君,谭子锋,等.不同潮气量机械通气治疗儿童重症肺炎系统性评价[J] .现代诊断与治疗,2018,29(7):10091011.
[5] 沈颖彦. 根据校正体重测算肥胖患者全身麻醉机械通气潮气量的可行性[D] .浙江大学,2014.
[6] Li H ，Zong XN，Ji CY，et al.Body mass index cutoffs for overweight and obesity in Chinese children and adolescents aged 218 years[J] .Chin J Epidemiol，2010，31(6):616620.
[7] 陈建丽，黄 莉，徐艳霞，等.危重患儿呼吸衰竭机械通气时呼吸力学动态监测及血气分析评价[J] .实用儿科临床杂志，2008，23 (18) :14181420.
[8] Sato H，Nakamura K，Baba Y.Low tidal volume ventilation with low PEEP during surgery may induce lung inflammation[J] .BMC Anesthesiol，2016，16 (1) :4755.〖ZK)〗
[9] 〖ZK(#〗Brian JE Jr. Carbon dioxide and the cerebral circulation [J] . Anesthesiology，1998，88 (5)：13651386.
[10] 郑剑秋,冯继峰.腹腔镜手术中二氧化碳气腹对小儿呼吸循环的影响[J] .微创医学,2013,8(4):488490,496.
[11] Feihl F，Perret C.Permissive hypercapnia.How permissiveshould we be?[J] .Am J Respir Crit Care Med，1994，150 (6) :1722.
[12] 沈颖彦,徐 佳,周红梅.根据校正体重测算消瘦患者全麻机械通气潮气量[J] .中国中西医结合外科杂志,2018,24(3):298301.

备注/Memo

备注/Memo:
*陕西省科技厅社会发展科技攻关项目（2016SF075） 陕西省卫生和计划生育委员会科研项目（2016D082）
更新日期/Last Update: 2019-09-24