麻醉诱导期开始采用肺保护性通气策略对妇科腔镜手术患者呼吸力学及肺氧合功能的影响
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摘要
目的探讨麻醉诱导期开始采用肺保护性通气策略对妇科腔镜手术患者呼吸力学及肺氧合功能的影响。方法选择行妇科腔镜手术的患者110例,随机分为A,B,C 3组,每组40例。麻醉诱导后进行不同的通气策略,A组为全手术期间均以潮气量10 ml/kg;B组为低VT组,以潮气量(VT)7 ml/kg;C组为低VT组+低PEEP+肺复张手法组,即全程使用VT 7 ml/kg,PEEP 5 cm H2O,同时每30 min进行一次手法肺复张。记录麻醉前,手术开始30 min,手术中60 min,90 min,手术结束后120 min的气道峰压(Ppeak),气道平台呀(Pplat),肺顺应性,并且在同一时间抽取患者动脉血进行血气分析,计算氧合指数和肺内分流率。结果 3组患者的Ppeak,CL值均随着时间延长而逐渐增高,但B组与C组升高趋势明显低于A组(P<0.05);3组患者的Pplat,OI值均随着时间延长而逐渐减少,但B组与C组降低趋势明显高于A组(P<0.05);同时在同一时间段,C组要低于B组,两组之间差异有统计学意义(P<0.05)。结论在妇科腔镜手术患者中,相较于传统的大潮气量通气策略,麻醉诱导期开始采用肺保护性通气策略对呼吸力学及肺氧合功能的改善更为明显。
Objective To explore the effect of pulmonary protective ventilation strategy on respiratory mechanics and oxygenation function in patients with gynecologic endoscopic surgery. Methods 110 patients with gynecological endoscopic surgery were selected, randomly divided into A,B and C groups, with 40 cases in each group. After anesthesia induction, different ventilation strategies were carried out. In group A, the air volume was 10 ml/kg during the whole operation. Group B was low VT group, with tidal volume(VT) 7 ml/kg; Group C was a group of low VT group + low PEEP + lung complex, that is, the whole process was using VT 7 ml/kg, PEEP 5 cm H2 O, and every 30 min was used for pulmonary resection. Record before anesthesia and surgery began 30 min, in 60 min, 90 min, 120 min after the operation of the airway peak pressure(Ppeak), airway platform(Pplat),lung compliance, and at the same time extraction in patients with arterial blood for blood gas analysis, calculating oxygenation index, and pulmonary Fen Liu Lv inside. Results Ppeakof three groups of patients' s CL values are gradually increased, but in group B and C group with prolonged rising trend, was obviously lower than that of group A(P<0.05); In 3 patients Pplat, OI values gradually decreased with time extend, reducing trend in group B and C group was obviously higher than that of group A(P<0.05), while at the same time, lower than group B, group C was statistically significant difference between the two groups(P<0.05). Conclusion In patients with gynecological endoscopy surgery, compared with the traditional spring tide volume ventilation strategy, anesthesia induction period began to adopt the strategy of lung protective ventilation on respiratory mechanics and pulmonary oxygenation function of improvement is more apparent.
Objective To explore the effect of pulmonary protective ventilation strategy on respiratory mechanics and oxygenation function in patients with gynecologic endoscopic surgery. Methods 110 patients with gynecological endoscopic surgery were selected, randomly divided into A,B and C groups, with 40 cases in each group. After anesthesia induction, different ventilation strategies were carried out. In group A, the air volume was 10 ml/kg during the whole operation. Group B was low VT group, with tidal volume(VT) 7 ml/kg; Group C was a group of low VT group + low PEEP + lung complex, that is, the whole process was using VT 7 ml/kg, PEEP 5 cm H2 O, and every 30 min was used for pulmonary resection. Record before anesthesia and surgery began 30 min, in 60 min, 90 min, 120 min after the operation of the airway peak pressure(Ppeak), airway platform(Pplat),lung compliance, and at the same time extraction in patients with arterial blood for blood gas analysis, calculating oxygenation index, and pulmonary Fen Liu Lv inside. Results Ppeakof three groups of patients' s CL values are gradually increased, but in group B and C group with prolonged rising trend, was obviously lower than that of group A(P<0.05); In 3 patients Pplat, OI values gradually decreased with time extend, reducing trend in group B and C group was obviously higher than that of group A(P<0.05), while at the same time, lower than group B, group C was statistically significant difference between the two groups(P<0.05). Conclusion In patients with gynecological endoscopy surgery, compared with the traditional spring tide volume ventilation strategy, anesthesia induction period began to adopt the strategy of lung protective ventilation on respiratory mechanics and pulmonary oxygenation function of improvement is more apparent.
引文
[1]陈伟.乌司他丁联合不同通气模式对妇科腔镜手术患者呼吸动力学的影响[D].皖南医学院,2015.
[2]Ladha K,Vidal Melo MF,Mc Lean DJ,et al.Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications:hospital based registry study[J].BMJ,2015,14(351):3646.
[3]Peng C,Ling Y,Ma C,et al.Safety Outcomes of NOTES Cholecystectomy Versus Laparoscopic Cholecystectomy:A Systematic Review and Meta-Analysis[J].Surg Laparosc Endosc Percutan Tech,2016,26(5):347-353.
[4]李锋,黄中华,张学刚,等.结直肠癌腹腔镜根治术气腹对患者呼吸和血流动力学的影响[J].广西医学,2011,33(4):428-431.
[5]陈静,赵铭力,万彬,等.无气腹腹腔镜与气腹腹腔镜子宫肌瘤剔除术对比分析[J].当代医学,2012,18(25):47-48.
[6]Ball L,Costantino F,Orefice G,et al.Intraoperative mechanical ventilation:state of the art[J].Minerva Anestesiol,2017,83(10):1075-1088.
[7]杨天星,叶碧华,李秀丹,等.小潮气量通气在具有发生急性呼吸窘迫综合征高危因素患者中的应用研究[J].检验医学与临床,2016,13(18):2573-2575.
[8]方瑜,金珍珍,何新霞.标准化肺泡-动脉氧分压差与氧合指数对重症肺炎患儿的临床诊疗和预后评估价值[J].现代实用医学,2017,29(8):1057-1059.
[9]Elliott JE,Duke JW,Hawn JA,et al.Increased cardiac output,not pulmonary artery systolic pressure,increases intrapulmonary shunt in healthy humans breathing room air and 40%O2[J].J Physiol,2014,592(20):4537-4553.
[2]Ladha K,Vidal Melo MF,Mc Lean DJ,et al.Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications:hospital based registry study[J].BMJ,2015,14(351):3646.
[3]Peng C,Ling Y,Ma C,et al.Safety Outcomes of NOTES Cholecystectomy Versus Laparoscopic Cholecystectomy:A Systematic Review and Meta-Analysis[J].Surg Laparosc Endosc Percutan Tech,2016,26(5):347-353.
[4]李锋,黄中华,张学刚,等.结直肠癌腹腔镜根治术气腹对患者呼吸和血流动力学的影响[J].广西医学,2011,33(4):428-431.
[5]陈静,赵铭力,万彬,等.无气腹腹腔镜与气腹腹腔镜子宫肌瘤剔除术对比分析[J].当代医学,2012,18(25):47-48.
[6]Ball L,Costantino F,Orefice G,et al.Intraoperative mechanical ventilation:state of the art[J].Minerva Anestesiol,2017,83(10):1075-1088.
[7]杨天星,叶碧华,李秀丹,等.小潮气量通气在具有发生急性呼吸窘迫综合征高危因素患者中的应用研究[J].检验医学与临床,2016,13(18):2573-2575.
[8]方瑜,金珍珍,何新霞.标准化肺泡-动脉氧分压差与氧合指数对重症肺炎患儿的临床诊疗和预后评估价值[J].现代实用医学,2017,29(8):1057-1059.
[9]Elliott JE,Duke JW,Hawn JA,et al.Increased cardiac output,not pulmonary artery systolic pressure,increases intrapulmonary shunt in healthy humans breathing room air and 40%O2[J].J Physiol,2014,592(20):4537-4553.