中心静脉压和气道压监测在经皮肾碎石术中的应用(1)
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【摘要】目的:通过对经皮肾镜碎石术麻醉期间持续气道压和中心静脉压的监测,预防和治疗可能出现的灌流液吸收综合征。方法:选择ASAⅠ或Ⅱ级择期上尿路结石经皮肾镜碎石术病人30例,实施全身麻醉,用力月西0.1mg.kg-1、异丙酚1.5mg.kg-1、顺苯磺酸阿曲库铵0.15mg.kg-1、芬太尼4μg.kg-1麻醉诱导,七氟醚1~1.3MAC持续吸入维持麻醉。分别测定术前、手术俯卧位、手术0.5小时、1小时、1.5小时、2小时或手术结束时、气道压(Paw)、中心静脉压(CVP)和血压(MBP)的值。结果:30例患者中29例顺利完成手术,手术时间90～150min,平均(118.97±13.58)min,冲洗液18000～29000ml,平均(23106.89±3543.70)ml,30例病人均痊愈出院;术中HR变化差异无显著性;与术前相比Paw T4、CVP T3、MBP T4、T5有明显的升高,差异有显著性P<0.05,CVP T4、T5有明显的升高,差异有显著性P<0.01。结论:CVP和Paw随手术时间的延长而升高,对CVP和Paw严密观察有助于预防灌流液吸收综合征的发生,对于较难处理的结石,或者估计手术时间长者,建议行分期手术,以提高病人的安全性。
【关键词】经皮肾镜碎石术;气道压;中心静脉压
doi:10.3969/j.issn.1006-1959.2010.08.089文章编号:1006-1959(2010)-08-2069-02
Evaluate monitoring of central venous pressure and airway pressure in Percutaneous nephrolithotripsyWU Li-xin,LIANG Jing-zhu,ZHANG Zhi-ang,LING-Quan,ZHANG Chun-yuanDepartment of Anesthesiology、Zhongshan people's hospital,Zhongshan 528400,china
【Abstract】Objective:To evaluate central venous pressure and airway pressure monitoring using in percutaneous nephrolithotripsy to Prevention and therapy perfusate absorbing sydrome.Methods:30 patients with calculus of kidney of ASAⅠorⅡ level were selected.After general anaesthesia,Anesthesia was induced with midazolam 0.1mg.kg-1,diprivan 1.5mg.kg-1,cisatracurium besilate 1.5mg.kg-1and fentanyl 4μg.kg-1.sevoflurane 1~1.3MAC to maintain anesthesia.we detected the central venous pressure,airway pressure and blood pressure at preoperative,operation beginning,0.5 hour,1 hour,2hour,2.5hours and the end of operation.Results:29 operation of 30 cases were completed successfully.Average time was (118.97±13.58)min and washing fluid was(23106.89±3543.70)ml,all these 30 patients were cured.During the operation there was no significance changes in HR,but Paw T4、CVP T3、MBP T4、T5 significantly step-up (P<0.05).Conclusion:CVP and Paw raised with the operation time going on.So keep detecting of CVP and Paw can prevent patients from perfusate absorbing sydrome,and we suggest to use Staging operation for difficult calculus operation to improve the safety of patients ......
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