摘要
目的探讨肺保护性通气策略对腹腔镜手术呼吸动力学及循环的影响。方法将100例ASAⅠ-Ⅱ级腹腔镜手术患者按随机数字表法分为传统机械通气组(A组)和肺保护性通气组(B组),每组50例。2组患者在麻醉诱导插管后行机械通气:潮气量为12 mL.kg-1,呼吸频率为12次.min-1,I∶E=1∶2。B组在气腹开始时将潮气量设为6 mL.kg-1,呼吸频率为16次.min-1,呼吸末正压(PEEP)为5 cmH2O。2组患者分别于气腹前、气腹毕、气腹后1 h及术毕测定平均气道压、动脉血气分析、心率、平均动脉压的变化。结果 B组气腹后各时点的平均气道压均低于A组(P<0.05);B组气腹后1 h及术毕PaCO2高于A组,pH低于A组(均P<0.05)。PaO2、心率、平均动脉压2组比较差异无统计学意义(均P>0.05)。结论肺保护性通气策略可降低腹腔镜手术中机械通气时的气道压,但PCO2会有一定程度的升高,对循环系统干扰不明显。
Objective To investigate the effect of protective lung ventilation strategy on respiration dynamic and circulation in laparoscopic operation.Methods 100 patients of ASA classⅠ-Ⅱundergoing laparoscopic operation were randomly number table method divided into conventional mechanical ventilation group（group A,n=50） and protective lung ventilation group（group B,n=50）.Mechanical ventilation was used in each group,with a tidal volume of 12 mL·kg^-1 and respiratory rate of 12 times per minute and inspiration/expiration ratio（I/E） of 1∶2.In group B,the tidal volume was adjusted to 6 mL·kg^-1,respiratory rate to 16 times per minute and PEEP 5 cmH2O just before pneumoperitoneum.The mean airway pressure,arterial blood gas analysis,heart rate,mean arterial pressure were observed at the time of before pneumoperitoneum,end of pneumoperitoneum,one hour after pneumoperitoneum and end of operation.Results The mean airway pressure in group B was significantly lower than group A after pneumoperitoneum（P〈0.05）.However,PaCO2 in group B was significantly higher than group A at one hour after pneumoperitoneum and the end of operation（P〈0.05）.The PaO2,heart rate and mean arterial pressure had no significant difference between the two groups（all P〈0.05）.Conclusion Lung protective ventilation strategy can reduce the mean airway pressure in laparoscopic operation,with the increase of PCO2,which has no significant side effect on circulation.
出处
《南昌大学学报（医学版）》
CAS
2010年第4期47-49,共3页
Journal of Nanchang University：Medical Sciences
关键词
肺保护性通气策略
腔镜手术
呼吸
循环
protective lung ventilation strategy
laparoscopic operation
respiration
circulation
