反比通气对妇科腹腔镜手术肥胖患者心肺功能和炎性因子的影响

发布时间：2018-01-23 00:07

本文关键词： 反比通气妇科腹腔镜肺损伤炎性因子　出处：《上海医学》2015年04期 　论文类型：期刊论文

【摘要】：目的探讨妇科腹腔镜手术中反比通气(IRV)对肥胖患者心肺功能和炎性因子的影响。方法将80例患者随机分为对照组(常规通气组)和IRV组,每组40例,全身麻醉后行机械通气,IRV组吸呼比为2∶1,常规通气组吸呼比为1∶2,两组患者的潮气量(VT)均为8mL/kg,呼吸频率(RR)均为12次/min。观察并记录麻醉前2min(T0)、麻醉后气腹开始前2min(T1)、气腹后60min(T2)和手术结束(T3)各时间点的血流动力学指标。采集T1、T2时间点的桡动脉血气分析呼吸道压力峰值(Ppeak),计算氧合指数(OI)和肺顺应性(CL)。采用ELISA法检测TNF-α、IL-6、IL-10水平,并观察并发症(如皮下气肿、误吸、苏醒延迟、气栓、肌肉酸痛等)的发生情况。结果两组在T2时间点的动脉血二氧化碳分压(paCO2)、平均气道压(Pmean)、Ppeak显著高于同组T1时间点(P值均0.05)。IRV组在T2时间点的动脉血氧分压(paO2)、OI和CL均显著高于常规通气组同时间点(P值均0.05),Ppeak、TNF-α、IL-6、IL-10水平均显著低于常规通气组同时间点(P值均0.05)。结论 IRV可有效降低行妇科腹腔镜术的肥胖患者机械通气时Ppeak,促进氧合,增加CL,减少炎性因子的释放,减轻肺损伤。
[Abstract]:Objective to investigate the effect of inverse ratio ventilation (IRV) on cardiopulmonary function and inflammatory factors in obese patients during laparoscopic gynecological surgery. Methods 80 patients were randomly divided into control group (conventional ventilation group) and IRV group. 40 patients in each group were given mechanical ventilation after general anesthesia. The breathing and breathing ratio of IRV group was 2: 1, and that of routine ventilation group was 1: 2. The tidal volume of both groups was 8 mL / kg. The respiratory rate (RR) was 12 / min. Observe and record T0 before anesthesia and 2 min before pneumoperitoneum began after anesthesia (T1). After pneumoperitoneum, 60 min after pneumoperitoneum (T2) and at the end of operation (T3), the blood gas of radial artery at T 1 T 2 time point was collected to analyze the peak respiratory pressure (Ppeak). The levels of IL-10 in TNF- 伪 and IL-6 were measured by ELISA method, and complications (such as subcutaneous emphysema, aspiration by mistake, delayed recovery) were observed. Results at T2 time point, the partial pressure of arterial blood carbon dioxide (PaCO2), mean airway pressure (Pmean). Ppeak was significantly higher than that of the same group at T1 time point (P = 0.05). The arterial partial pressure of oxygen (PaO2) was significantly higher in IRV group than that in the same group at T2 time point (P < 0.05). Both OI and CL were significantly higher than those of routine ventilation group at the same time point (P = 0.05). The level of IL-10 was significantly lower than that of routine ventilation group (P < 0.05) at the same time point. Conclusion IRV can effectively reduce the level of Ppeak during mechanical ventilation and promote oxygenation in obese patients undergoing gynecological laparoscopy. Increase CLS, reduce the release of inflammatory factors, and reduce lung injury.
【作者单位】：浙江大学医学院附属第一医院麻醉科;嘉兴市妇幼保健院麻醉科;
【分类号】：R614
【正文快照】： 机械通气性肺损伤(VILI)是近年来的研究热点。腹腔镜手术引起机体一系列病理生理改变,如CO2气腹对呼吸、循环的影响,再加上妇科腹腔镜手术要求极低头低位,对妇科肥胖患者的呼吸影响极大,较易引起各种气压伤或潜在并发症,可诱发或加重肺损伤。反比通气(IRV)由于吸气时间延长,在

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