Makita K, Uchida T, Toyooka H, Amaha K
Department of Anesthesiology and Critical Care Medicine, Tokyo Medical and Dental University, Shool of Medicine.
Masui. 1994 Nov;43(11):1675-9.
This study was performed to examine the hypothesis that PSV with PEEP compared to spontaneous breathing with a circle anesthesia system may have beneficial effects on gas exchange and work of breathing during inhalational anesthesia. Nine patients (age; 58 +/- 20 yr) scheduled to receive general anesthesia for orthopedic (n = 3) or ENT (n = 6) surgery were randomly assigned in a triple cross-over manner to breathe with a standard anesthesia circle system, 5 cmH2O PSV, and 5 cm H2O PSV above 5 cmH2O PEEP. General anesthesia was induced with thiamylal (5 mg.kg-1) and succinylcholine (1 mg.kg-1), followed by tracheal intubation. General inhalation anesthesia was maintained with 1% isoflurane and nitrous oxide in 40% oxygen. Patients were permitted to breathe spontaneously. A BiPAP-S Ventilatory Support System was connected to a standard anesthesia machine instead of a reservoir bag to deliver PSV or PSV with PEEP. Respiratory parameters were measured with a C-P 100 Pulmonary Monitor. After breathing for 20 minutes with the assigned mode, measurements and blood gas sampling were performed. Statistical analysis was performed with ANOVA. There were no statistical differences in PaO2 within the three groups (table). PaCO2 was lower during PSV+PEEP, but the difference was not significant. This level of PSV or PSV with PEEP may have little beneficial effects on gas exchange in our study condition. The mean WOBp was smaller in the PSV with PEEP group but the difference was not statistically significant.
与使用循环麻醉系统自主呼吸相比，压力支持通气（PSV）联合呼气末正压（PEEP）在吸入麻醉期间可能对气体交换和呼吸功有益。9例计划接受骨科手术（n = 3）或耳鼻喉科手术（n = 6）的全身麻醉患者，采用三交叉方式随机分配，分别使用标准麻醉循环系统、5 cmH₂O的PSV以及5 cmH₂O PEEP加5 cmH₂O的PSV进行呼吸。全身麻醉诱导采用硫喷妥钠（5 mg·kg⁻¹）和琥珀酰胆碱（1 mg·kg⁻¹），随后进行气管插管。采用1%异氟烷和40%氧气中的氧化亚氮维持全身吸入麻醉。允许患者自主呼吸。将一台BiPAP-S通气支持系统连接到标准麻醉机上，取代贮气囊以提供PSV或PSV联合PEEP。使用C-P 100肺功能监测仪测量呼吸参数。在以指定模式呼吸20分钟后，进行测量和血气采样。采用方差分析进行统计分析。三组的动脉血氧分压（PaO₂）无统计学差异（表）。PSV + PEEP期间动脉血二氧化碳分压（PaCO₂）较低，但差异不显著。在我们的研究条件下，这种水平的PSV或PSV联合PEEP对气体交换可能几乎没有有益影响。PSV联合PEEP组的平均呼吸功（WOBp）较小，但差异无统计学意义。
