摘要目的 探讨呼气末正压(PEEP)通气对嗜烟病人全身麻醉时体温调节功能的影响.方法 择期全身麻醉下行腹部手术病人20例,男性,年龄26～52岁,ASA分级Ⅰ或Ⅱ级,吸烟量≥10支/d,烟龄≥6年.采用随机数字表法,将病人随机分为2组(n=10):对照组(C组)与PEEP组(P组).全身麻醉诱导气管插管后行间歇正压通气(IPPV).气管插管后10～180min,PEEP组在IPPV的基础上加10 cm H2O PEEP,C组仅采用IPPV(PEEP0).以麻醉诱导前为对照值(T0),于气管插管后每隔30 min记录HR、MAP、食道温(TES)、平均皮肤温(TMSK)、食道-平均皮肤温度差(TES-MSK),直到气管插管后180min.同时记录周围血管收缩阈值,计算其增益.结果 两组MAP、HR均波动在正常范围,组间比较差异无统计学意义(P＞0.05).与T0时比较,两组气管插管后各时点TES、TES-MSK降低,TMSK升高(P＜0.05).两组间TES、TMSK、TES-MSK、周围血管收缩阈值及其增益比较差异无统计学意义(P＞0.05).结论 PEEP通气不能改善嗜烟病人全身麻醉时体温调节的功能.

abstractsObjective To investigate the effect of positive end expiratory pressure (PEEP) on thermo-regulatory function during general anesthesia in patients addicted to smoking. Methods Twenty adult male ASA Ⅰ or Ⅱ patients who had been smoking more than or equal to 10 cigarettes per day for more than or equal to 6 years were studied. The patients underwent intra-abdominal surgery under general anesthesia and were randomly divided into 2 groups ( n = 10 each): control group (group C) and PEEP group (group P). Anesthesia was induced with propofol, fentanyl and vecuronium and maintained with inhalation of 1%-2% isoflurane and continuous iv infusion of remifentanil and vecuronium. The patients were mechanically ventilated after tracheal intubation. In group P PEEP of 10 cm H2O was added. Temperature probe was inserted into the lower segment of esophagus and placed on the anterior chest wall, medial surface of thigh anterior surface of forearm and palmar surface of the tip of index finger. Mean skin temperature (TMSK) was calculated according to Roberts. MAP, HR, TES, TMSK and the difference between TES and TMSK (TES-MSK) were recorded before induction of anesthesia (T0 ,baseline) and every 30 min after tracheal intubation. Esophageal temperature was taken as threshold of thermo-regulatory peripheral vasoconstriction when the difference between forearm and finger tip temperature = 0 ℃. The gain in the threshold was calculated according to Sessler. Results TES and TES-MSK significantly decreased,while TMsK increased after tracheal intubation in both groups ( P ＜ 0.05). There was no signifieant difference in TES, TMSK, TES-MSK, MAP, HR, the threshold of vasoconstriction and gain between the 2 gronps ( P ＞ 0.05). Conclusion PEEP cannot improve thermo-regulatory function during general anesthesia in smoking-addicted patients.