七氟烷联合肺保护性通气策略对行腹腔镜减重手术的肥胖患者肺通气功能和肺顺应性的影响

Impacts of sevoflurane combined with lung protective ventilation strategy on pulmonary ventilation function and lung compliance in obese patients undergoing laparoscopic weight loss surgery

摘要:

目的 探讨七氟烷联合肺保护性通气策略对行腹腔镜减重手术的肥胖患者肺通气功能和肺顺应性的影响。方法 将60例行腹腔镜减重手术的肥胖患者随机分为对照组（麻醉时单纯给予肺保护性通气策略干预）和研究组（给予七氟烷吸入麻醉联合肺保护性通气策略干预），于气管插管前（T₀）、气管插管后5 min（T₁）、气管插管后40 min（T₂）和气管拔管后5 min（T₃）抽取患者动脉血行血气分析，比较两组患者肺通气功能和肺顺应性等情况。结果 研究组T₂时点气道峰压（Ppeak）和气道平台压（Pplat）低于对照组，差异均有统计学意义（P < 0.05）；T₂和T₃时点，研究组动态肺顺应性（C_ldyn）高于对照组，差异均有统计学意义（P < 0.05）；术后7 d，研究组用力肺活量（FVC）和第一秒用力呼气容积（FEV₁）高于对照组，差异均有统计学意义（P < 0.05）；T₁、T₂和T₃时点，研究组血清转化生长因子-β1（TGF-β1）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平低于对照组，差异均有统计学意义（P < 0.05）；术后，研究组苏醒时间、自主呼吸恢复时间和拔管时间短于对照组，苏醒期不良事件少于对照组，苏醒后Ramsay评分低于对照组，差异均有统计学意义（P < 0.05）。结论 七氟烷联合肺保护性通气策略能够减轻腹腔镜减重手术肥胖患者炎症反应，改善肺通气功能，提高肺顺应性，且安全性好，术后恢复快。

Abstract:

Objective To investigate the impacts of sevoflurane combined with lung protective ventilation strategy on pulmonary ventilation function and lung compliance in obese patients undergoing laparoscopic weight loss surgery.Methods 60 obese patients underwent laparoscopic weight loss surgery were randomly divided into two groups. The control group was given lung protective ventilation intervention alone during anesthesia, and the study group was given sevoflurane inhalation anesthesia combined with lung protective ventilation intervention. Arterial blood was collected before tracheal intubation (T₀), 5 min after tracheal intubation (T₁), 40 min after tracheal intubation (T₂) and 5 min after tracheal extubation (T₃) for blood gas analysis. The pulmonary ventilation function and lung compliance of patients in the two groups were compared.Results Peak airway pressure (Ppeak) and plateau airway pressure (Pplat) at T₂ were lower in the study group than those in the control group, and the differences were statistically significant (P < 0.05); At T₂ and T₃ time points, the dynamic lung compliance (C_ldyn) of the study group was higher than that of the control group, and the differences were statistically significant (P < 0.05); 7 days after surgery, the forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁) in the study group were higher than those in the control group, and the differences were statistically significant (P < 0.05); At time points T₁, T₂ and T₃, the levels of serum transforming growth factor-β1 (TGF-β1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in the study group were lower than those in the control group (P < 0.05); After surgery, the awakening time, spontaneous breathing recovery time, and extubation time in the study group were shorter than those in the control group, the number of adverse events during the recovery period was less than that in the control group, after awakening, the Ramsay score was lower than that in the control group (P < 0.05).Conclusion The combination of sevoflurane and lung protective ventilation strategy can reduce inflammatory response, improve pulmonary ventilation function, and improve lung compliance in obese patients undergoing laparoscopic weight loss surgery, with good safety and fast postoperative recovery.