摘要
目的通过同步膈肌超声和肺超声评价人工气腹下膈肌移动度和肺不张的超声影像学变化,探讨人工气腹手术麻醉时可能出现气体交换异常的机制。方法根据入选标准,随机选择行气管插管全麻下腹腔镜胆囊切除术患者37例。分别在麻醉前自主呼吸时(T0)、麻醉后机械通气5 min时(T1)、人工气腹稳定后5 min(T2)、机械通气时人工气腹结束后5 min(T3)、气管导管拔除后15 min(T4)5个时点采用M-型超声监测膈肌移动度以及采用B-型超声监测肺部超声影像。分别记录膈肌移动度以及上BLUE点、下BLUE点和膈肌点所监测的超声影像进行LUS评分。结果 (1)T0、T2、T4时点膈肌移动度分别为(12.07±2.70)mm、(4.52±0.81)mm、(10.17±1.99)mm。T1~T4时点膈肌移动度测量值与T0时点比较都下降(P <0.01);膈肌移动度在T2时点最小,与其他各时点比较差异有统计学意义(P <0.01);膈肌移动度在T4与T0时点比较差异仍然有统计学意义(P <0.01)。(2)T0、T2、T4时点LUS评分分别为(0.05±0.23)分、(2.19±0.57)分、(0.81±0.40)分。T1~T4时点LUS评分与T0时点比较显著性增高(P <0.01);LUS评分在T2时点最大,与其他各时点比较差异有统计学意义(P <0.01);T4时点LUS评分与T0时点比较差异仍然有统计学意义(P <0.01)。结论采用超声可以同步监测膈肌移动度和肺泡萎陷(肺不张),显示全麻气腹胆囊切除术会引起较严重的肺泡萎陷(肺不张),由人工气腹后膈肌移动度明显受限所致;这种肺下部的肺泡萎陷(肺不张)是可恢复的,但在麻醉复苏期仍然不能恢复到麻醉前水平。
Objective To evaluate the ultrasonographic changes of diaphragmatic muscle mobility and atelectasis in artificial pneumoperitoneum by synchronous diaphragmatic ultrasound and pulmonary ultrasound,and to explore the mechanism of gas exchange abnormality during artificial anesthesia. Methods According to the inclusion criteria,37 patients underwent laparoscopic cholecystectomy under general anesthesia with tracheal intubation. They were spontaneously breathing before anesthesia(T0),5 minutes after mechanical ventilation(T1),5 minutes after artificial pneumoperitoneum stabilization(T2),5 minutes after mechanical ventilation,5 minutes after endotracheal intubation(T3),and 15 minutes after endotracheal intubation(T4). M-mode ultrasound was usedtomonitordiaphragmaticmobilityat 5 timepointsandpulmonaryultrasoundimagesweremonitoredusingB-mode ultrasound. Ultrasound images monitored by diaphragmatic mobility and upper BLUE,lower BLUE,and diaphragm points were recorded for LUS score. Results(1)The mobility of the diaphragm at T0,T2 and T4 was(12.07 ±2.70)mm,(4.52 ± 0.81)mm and(10.17 ± 1.99)mm,respectively. At the time of T1 ~ T4,the measurement of diaphragmatic mobility decreased compared with T0(P < 0.01);the mobility of diaphragm was the smallest at T2,and the difference was statistically significant(P < 0.01);There was still a significant difference in mobility between T4 and T0(P < 0.01).(2)The LUS scores of T0,T2 and T4 were(0.05 ± 0.23),(2.19 ± 0.57)and(0.81 ± 0.40),respectively. The LUS score at T1 ~ T4 was significantly higher than that at T0(P < 0.01). The LUS score was the highest at T2,and the difference was statistically significant(P < 0.01). At the time of T4,there was still a significant difference between the score at the T0 time point(P < 0.01). Conclusions Ultrasound can be used to synchronously monitor diaphragmatic mobility and alveolar collapse(lung atelectasis). It shows that general anesthesia and abdominal cholecystectomy will cause more severe alveolar collapse(lung atelectasis),mainly The reason was due to the obvious limitation of diaphragmatic muscle mobility after artificial pneumoperitoneum;and it was detected that the alveolar collapse(insufficiency)in the lower part of the lung was recoverable,but it could not be restored to the pre-anesthesia level during the anesthesia recovery period.
引文
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