Nakae Y, Miyabe M, Sonoda H, Tamiya K, Namiki A
Department of Anesthesia, Hokkaido Children's Medical Center, Japan.
Anesth Analg. 1996 Sep;83(3):488-92. doi: 10.1097/00000539-199609000-00008.
The purpose of this study was to compare the Jackson-Rees circuit with the pediatric circle and MERA F breathing system (MERA F system) for pediatric anesthesia from the viewpoint of work of breathing (WOB). Twenty-three children (2-10 yr old) were studied during spontaneous breathing under endotracheal anesthesia with 4 L/min nitrous oxide, 2 L/min oxygen, and 1% end-tidal concentration of sevoflurane. WOB, inspiratory and expiratory airway resistance, dynamic compliance (CDYN), pressure time product (PTP), and arterial blood gasses were measured in the three circuits. The inspiratory WOB was estimated directly by measuring the esophageal pressure-volume loop using the Campbell technique. In a laboratory study, we measured the compliances of the Jackson-Rees circuit, the pediatric circle, the MERA F system, and the adult circuit. WOB differed among the three circuits (MERA F system > pediatric circle > Jackson-Rees circuit). Inspiratory and expiratory resistances, and arterial carbon dioxide tension in the Jackson-Rees circuit were significantly lower than those of both the pediatric circle and MERA F system. The CDYN and PTP in the MERA F system were significantly higher than those in both the Jackson-Rees circuit and the pediatric circle. The MERA F system had significantly higher compliance than the Jackson-Rees circuit and pediatric circle. It is concluded that the Jackson-Rees circuit is most efficient, the pediatric circle is intermediate, and the MERA F system is the least efficient from the viewpoint of WOB during spontaneous breathing for pediatric anesthesia.
本研究的目的是从呼吸功（WOB）的角度比较杰克逊-里斯回路、小儿麻醉回路和MERA F呼吸系统（MERA F系统）用于小儿麻醉的情况。对23名儿童（2至10岁）在气管内麻醉下自主呼吸时进行研究，吸入4 L/min氧化亚氮、2 L/min氧气以及呼气末七氟醚浓度为1%。在这三种回路中测量了呼吸功、吸气和呼气气道阻力、动态顺应性（CDYN）、压力时间乘积（PTP）以及动脉血气。吸气呼吸功通过使用坎贝尔技术测量食管压力-容积环直接估算。在一项实验室研究中，我们测量了杰克逊-里斯回路、小儿麻醉回路、MERA F系统和成人回路的顺应性。三种回路的呼吸功有所不同（MERA F系统>小儿麻醉回路>杰克逊-里斯回路）。杰克逊-里斯回路中的吸气和呼气阻力以及动脉二氧化碳分压显著低于小儿麻醉回路和MERA F系统。MERA F系统中的CDYN和PTP显著高于杰克逊-里斯回路和小儿麻醉回路。MERA F系统的顺应性显著高于杰克逊-里斯回路和小儿麻醉回路。得出的结论是，从小儿麻醉自主呼吸时的呼吸功角度来看，杰克逊-里斯回路效率最高，小儿麻醉回路居中，MERA F系统效率最低。
