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| 电阻抗成像法评价顺式阿曲库铵对老年膝关节置换术患者肺通气功能的影响 |
| Evaluation of the effect of cis-atracurium on lung ventilation function in elderly patients undergoing knee replacement by electrical impedance tomography |
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| DOI：10.12089/jca.2020.07.006 |
| 中文关键词: 电阻抗成像 顺式阿曲库铵 老年 膝关节置换 肺通气 |
| 英文关键词: Electrical impedance tomography Cis-atracurium Elderly Knee replacement Lung ventilation |
| 基金项目:安徽省科技攻关项目（1704a0802165） |
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| 摘要点击次数: 1928 |
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| 中文摘要: |
目的 采用电阻抗成像法（EIT）评价顺式阿曲库铵在老年患者膝关节置换术中对肺通气功能的影响。
方法 选择择期行人工膝关节置换术的老年患者60例，男14例，女46例，年龄65~80岁，ASA Ⅱ或Ⅲ级，随机分两组：为使用顺式阿曲库铵组（C组）和不使用顺式阿曲库铵组（N组），每组30例。C组在全麻时使用顺式阿曲库铵0.15 mg/kg诱导，N组在全麻时不使用顺式阿曲库铵诱导。分别在麻醉诱导前（T0）、喉罩置入后5 min（T1）、喉罩置入后30 min（T2）、喉罩置入后60 min（T3）、拔除喉罩后5 min（T4）实施EIT监测，记录中心通气区（CoV）面积百分比、依赖静止区（DSS）面积百分比、非依赖静止区（NSS）面积百分比及T1—T3时气道压力；术前、术后1、3、5 d进行肺功能检测和血气分析。记录术后3 d内不良反应发生情况。
结果 T0、T3、T4时两组NSS、CoV和DSS面积百分比差异无统计学意义。T1、T2时C组CoV面积百分比明显高于N组（P＜0.05）。T1—T3时C组气道压力明显低于N组（P＜0.05）。两组术前和术后1、3、5 d的第一秒用力呼气容积（FEV1）、用力肺活量（FVC）、最大通气容积（MVV）、PaO2、PaCO2及氧合指数（PaO2/FiO2）差异无统计学意义。两组不良反应发生率差异无统计学意义。
结论 顺式阿曲库铵可改善膝关节置换术患者术中通气情况，对术后肺功能无明显影响。 |
| 英文摘要: |
Objective To evaluate the effect of cis-atracurium on lung ventilation in elderly patients undergoing knee replacement with electrical impedance tomography (EIT).
Methods Sixty elderly patients, 14 males and 46 females, aged 65-80 years, falling into ASA physical status Ⅱ or Ⅲ, undergoing elective knee replacement from June 2018 to June 2019 were selected. They were randomly divided into group with cis-atracurium （group C）and group without cis-atracurium （group N）, with 30 cases in each group. During general anesthesia, group C was induced with cis-atracurium 0.15 mg/kg while group N group was not. EIT monitoring was performed before anesthesia (T0), 5 min (T1), 30 min (T2) and 60 min (T3) after laryngeal mask insertion and 5 min after laryngeal mask removal (T4). The percentage of central ventilation area (CoV), percentage of the area of dependent silent spaces (DSS), percentage of the area of non-dependent silent spaces (NSS) and airway pressure from T1 to T3 were recorded. Lung function and blood gas analysis were analyzed before and 1, 3 and 5 d after operation. The occurrence of adverse reactions within 3 d after operation in both groups was recorded.
Results There was no significant difference in the percentage of NSS, CoV or DSS area between the two groups at T0, T3 and T4. The percentage of CoV area in group C was higher than that in group N at T1and T2(P < 0.05). The airway pressure of group C was significantly lower than that of group N from T1 to T3(P < 0.05). The differences between two groups in the forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), maximum ventilation volume (MVV), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) or oxygenation index (PaO2/FiO2) before operation and at the 1, 3 and 5 d after operation and the incidence of adverse reactions were of no significance statistically.
Conclusion Cis-atracurium can improve intraoperative ventilation in patients with knee arthroplasty and has no significant effect on postoperative pulmonary function. |
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