不同腹腔镜手术C02气腹对患者呼吸动力学的影响

Effects of CO2 pneumoperitoneum of different laparoscopic surgeries on pneumodynamics

摘要:

目的 评价不同腹腔镜手术C02气腹对患者呼吸动力学的影响。方法 择期行腹腔镜全麻手术女性患者40例，ASA分级Ⅰ级或Ⅱ级，年龄20-60岁,体重指数18-24kg/㎡，按照腹腔镜手术类别，将患者随机分为２组：妇科腹腔镜组（LG组），胆囊腹腔镜组（LC组），每组20例。麻醉诱导维持用药相同，气管插管后行机械通气，于入室基础值（T0）、气腹即刻（T1）、体位改变后气腹5min（T2）、气腹后20min（T3）、放气后5min（T4）、手术结束后（T5）时记录顺应性（Cl）、阻力（Raw）、气道峰压（Pmax）、平台压(Pplat) 、平均压（Pmean）等呼吸动力学参数。结果 与T0时比较，两组T1-T3时Raw、Pmax、Pplat、Pmean显著升高（P<0.01），LG组T4-T5时Pmax、Pplat升高（P<0.05），T1-T5时Cl显著降低（P<0.01），LC组T1-T3时显著降低（P<0.01），T4-T5时降低（P<0.05）。与LG组比较，LC组T2时Cl显著降低（P<0.01），T3时降低（P<0.05）。结论 两种腹腔镜手术CO2气腹对患者呼吸动力学各项指标皆有一定的影响，而妇科手术时的Trendelenburg体位较LC的头高位对呼吸动力学的影响更明显。

Abstract:

【Objective】 To investigate the effects of CO2 pneumoperitoneum of different laparoscopic surgeries on pneumodynamics monitored by side stream spirpometry. 【Methods】 Forty patients (ASA classification Ⅰor Ⅱ), aged 20~60y, with a body index of 18~24 kg/㎡, scheduled for laparoscopic surgery under general anesthesia, were randomly divided into 2 groups(n =20): Gynecological laparoscopic group(group LG) and Gallbladder laparoscopic group (group LC). Anesthesia was induced with midazolam,fentanil, propofol and vecuronium. The patients were tracheal intubated and mechanically ventilated. The respiratory mechanic parameters of compliance(CL), resistance (Raw), peak airway pressure (Pmax), plateau pressure (Pplat), mean pressure (Pmean), positive end expiratory pressure (PEEP) were recorded at the time of supine position (T0), the pneumoperitoneum instantly (T1), 5 min of pneumoperitoneum after changing position (T2), pneumoperitoneum after 20 min (T3), deflating after 5 min (T4) and after the end of the surgery (T5). 【Results】 The Raw, Pmax, Pplat, Pmean were significantly higher after CO2 pneumoperitoneum in the two groups (P <0.01). The Pmax, Pplat after deflating CO2 were higher in group LG (P <0.05), whereas it didn't happen in group LC(P >0.05). The Cl, which was significantly lower after CO2 pneumoperitoneum in both groups(P <0.01), was significantly lower after deflating CO2 in group LG(P <0.01) and was lower in group LC(P <0.05). Compared with group LG, the Cl was significantly lower at T2(P <0.01) and lower at T3(P <0.05). 【Conclusion】 CO2 pneumoperitoneum showed a certain effect on the respiratory function of the patients in both laparoscopic surgeries, and the effects of Trendelenburg position were significantly obvious when compared with those in laparoscopic laparoscopic cholecystectomy.