三因素三水平呼吸参数在腹腔镜手术全麻中的选用
李占芳 姜波 黄建明 唐卫青 吴一鸣
(上海市南汇区中心医院 麻醉科 201300)
探讨腹腔镜手术Co2气腹（高腹压12mmHg）状态下全麻控制呼吸中，
较低气道压力同时又能维持良好通气的呼吸参数的选用（最佳组合）。 取麻醉机上最基本的呼吸频率（F）、潮气量（VT）、吸呼比(I:E)三参数作为三因素A、B、C, 取F=15、12、9（次/分），VT=8、10、12（ml/kg体重），I:E=1:2.5、1: 2.0、
41:1.5为相应的三水平；以L9(3) K=3重复正交实验设计及
分析
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用表统计、检验、
分析各因素及水平变化影响吸气峰压()、气道平均压（）、呼末气道压（）及呼末二氧化碳分压(的统计学意义，从而找出因素间不同水平
即不同呼吸参数的最佳组合方式。 本文设定的呼吸参数中，三因素三水平
的不同组合?对吸气峰压()的影响无统计学的意义，但潮气量（B因素三水平）的不同对有影响趋势。?呼吸频率（A因素三水平）的改变对Petco2的影响有显著的统计学意义。?吸呼比（C因素三水平）的不同对气道平均压（）的影响有较显著的统计学的意义。 三因素三水平呼吸参数的最佳组合方
式是A2B2C2亦即F=12次/分、VT=10ml/kg体重、I:E=1:2.0。即非近年的小潮气
量快频率通气策略，也非大潮气量慢频率的传统通气方法。如此才能获得腹腔镜
手术Co2气腹（高腹压）状态下全麻控制呼吸中“较低气道压力同时又能维持良
[1]好通气”的肺保护效应。值得提醒的是I:E对的影响亦即对肺保护的影响
有着重要的意义。
三因素三水平; 呼吸参数; 气道平均压; 肺保护
Objective: To study the best combination of different
respiratory parameters that has “lower airway pressure with maintaining
good ventilation”, under the general anesthesia with laparoscopy, Which
is important for Lung protections. Methods: Take on the basic breathing
parameters of the anesthesia machine frequency(F)、tidal volume(VT) and
respiration ratio (I:E) as three factors A B C, take F =15 12 9 (bpm)、
VT =8 10 12 (ml/kg weight)、I:E =1:2.5 1:2.0 1:1.5 as three levels ;Adopt
4(3) K=3 repeat orthogonal experimental design and statistical analysis L9
each statistical significance of various factors effecting the peak
inspiratory pressure(PIP),the average airway pressure (Pmean),the
end-tidal airway pressure (PeeP)and end-tidal carbon dioxide partial
pressure(Petco2),and find out the best combination. Results:The
different combinations of three factors-levels based on the parameters
setted by this article:?has not statistical significance on PIP, but has effecting trend with the different tidal volume. ? The effect of the F
has a notable statistical significance on the Petco2.? The effect of the
I:E for lung protection or Pmean has relatively notable statistical
significanceConclusion: The best combinations of three factors-levels
respiratory parameters is A2B2C2 (F = 12 bpm VT =10 ml/kg weight I:E
= 1:2.0).Not small tidal volume with fast frequency no large tidal volume
with slow frequency. In this way can get on the lung protective effect
which with “lower airway pressure with maintaining good ventilation”
on the control of respiration under the general anesthesia with
laparoscopy .It is worth mentioning that the effect of I:E for lung
protection or Pmean has major significance.
Three factors-levels; Respiratory parameters; The
average
airway pressure; Lung protection
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