Pelin DİNÇER ÇORMAN, Murat ÜNSEL, Cengiz YUMRU

Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri

Amaç: Çalışmamızın amacı pron pozisyonda cerrahi girişim geçirecek lumber diskopatili hastalarda 10cm H2 O ekspirasyon sonu pozitif basınç (positive end-expiratory pressure (PEEP)) uygulamasının arteriyel oksijenizasyon, solunum mekaniği ve dolaşım sistemi üzerindeki etkilerini araştırmaktır. Hastalar ve Yöntem: Pron pozisyonda lumber diskektomi operasyonu geçirecek Amerikan Anesteziyoloji Derneği (The American Society of Anesthesiologists (ASA)) kriterlerine göre I-II sınıf, 40 hasta çalışmaya alındı. Anestezi indüksiyonu ve endotrakeal entübasyondan sonra hastalar aralıklı pozitif basınçlı ventilasyon (intermittent positive pressure ventilation (IPPV)) modunda %60 N2 O-%40 O2 , akım 4L.dk-1 ve sevoflurane 0.7- 1.0 minimum alveolar konsantrasyon (MAK) olacak şekilde ventile edildi. Hastalar randomize edilerek 2 gruba ayrıldı. PEEP 0 grubunda, PEEP 0 cm H2 O, PEEP 10 grubunda, PEEP 10 cm H2 O olarak ayarlandı. Solunum sayısı 10 soluk/dk, inspirasyonekspirasyon oranı 1:2, tidal volüm 8ml.kg-1 olacak şekilde sabit tutuldu. İndüksiyondan 10 dk, pron pozisyona döndükten sonra 15-30-45-60-75-90. dakikalarda kan gazı örnekleri alındı. Vital parametreler, dinamik kompliyans değerleri ve yan etkiler kaydedildi. Bulgular: Ortalama kan basıncı değerleri PEEP 10 grubunda pron dönemde diğer dönemlere göre istatistiksel olarak düşük bulundu (p

Anahtar Kelimeler:

PEEP, Pron pozisyon, Solunum mekaniği, Oksijenizasyon, Peroperatif ventilasyon

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Objectives: To evaluate the changes in arterial oxygenation and vital parameters by applying 10cm HO positive end-expiratory pressure (PEEP) to patients undergoing lumbar spine surgery in the prone position. Patients and Method: According to The American Society of Anesthesiologists (ASA) status I-II, 40 patients, scheduled for lumbar discectomy in the prone position were enrolled in the study. During the anesthesia induction and after intubation they were ventilated with intermittent positive pressure ventilation (IPPV) mode, 60%NO-40%O, 4L.min flow and 0.7-1.0 minumum alveolar concentration (MAC) sevoflurane. The patients were randomized into 2 groups. PEEP value was set at 0 cm HO in PEEP 0 group and at 10 cm HO in PEEP 10 group. Respiratory rate 10/min, inspiration-expiration ratio 1:2 and tidal volume 8ml.kgwere kept constant. Blood gas samples were obtained 10 min after induction and 15-30-45-60-75-90 min after prone positioning. Vital parameters, dynamic compliance and side effects were recorded. Results: Mean blood pressure was statistically low in PEEP 10 group at the prone positioning, compared to the other periods (p

Keywords:

PEEP, Prone positioning, Respiratory mechanics, Oxygenation, Peroperative ventilation,

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