EIT指导的肺保护性通气在腹腔镜手术中的应用研究

发布时间：2018-03-27 13:15

本文选题：电阻抗断层成像(EIT)　切入点：腹腔镜手术　出处：《第二军医大学》2017年硕士论文

【摘要】：第一部分在EIT指导下探讨腹腔镜手术肺保护性通气策略的最佳PEEP值目的以EIT监测技术为指导,探讨适合腹腔镜手术患者肺保护性通气的最佳PEEP值。方法及材料将符合纳入标准的研究对象编入同一研究组,研究对象在麻醉诱导后采用低潮气量容量控制通气,联合手法复张,PEEP逐步升高(0 cm H2O,6 cm H2O,8 cm H2O,10 cm H2O,12 cm H2O,14 cm H2O),在不同PEEP下观察研究对象呼吸系统指标和循环系统指标。通过EIT监测得到腹腔镜手术保护性肺通气的最佳PEEP值。结果在腹腔镜手术中,以EIT为指导的肺保护性通气的最佳PEEP值为8 cm H2O。在PEEP值为8 cm H2O时,研究对象的EIT监测肺背侧区域(ROI3和ROI4)达到最大、肺腹侧区域(ROI1和ROI2)达到最小。结论EIT指导下的腹腔镜患者肺保护性通气最佳PEEP值为8 cm H2O。第二部分EIT指导的肺保护性通气策略对腹腔镜手术患者肺功能的影响目的探讨EIT指导的肺保护性通气策略对腹腔镜手术患者肺功能的影响。方法将符合纳入标准的研究对象随机分配到肺保护通气组(Y组)和正常通气组(N组)。肺保护通气组采用低潮气量通气联合手法复张和EIT监测下的最佳PEEP,正常通气组采用常规潮气量通气,不联合手法复张和PEEP(PEEP值为0 cm H2O)。比较研究两组患者在不同通气策略下EIT监测、氧合指标和循环系统指标的变化情况。结果(1)肺保护通气组(Y组)和正常通气组(N组)的EIT监测肺背侧区域(ROI3和ROI4)在气腹开始后(T2)、气腹结束后(T3)有显著统计学差异(P0.05);肺保护通气组(Y组)和正常通气组(N组)的EIT监测肺腹侧区域(ROI1和ROI2)在气腹开始后(T2)、气腹结束后(T3)无显著统计学差异(P0.05);(2)两组的氧合指标在手术过程中(T2~T3)和手术麻醉结束后(T4)有显著统计学差异(P0.05)。结论EIT指导下的肺保护通气策略可改善腹腔镜手术患者肺功能、降低腹腔镜手术患者肺不张的发生率,提高术中和术后肺部氧合功能。
[Abstract]:In the first part, under the guidance of EIT, the optimal PEEP value of lung protective ventilation strategy for laparoscopic surgery was discussed. Objective to study the optimal PEEP value of lung protective ventilation under the guidance of EIT monitoring technique. To explore the best PEEP value for lung protective ventilation in patients undergoing laparoscopic surgery. Methods and materials were included in the same study group. The subjects were treated with low tidal volume controlled ventilation after anesthesia induction. In combination with manual peep, 0 cm H 2O 6 cm H 2O 6 cm H 2O 8 cm H 2O 10 cm H 2O 10 cm H 2O 12 cm H 2O and 14 cm H 2O 4 cm H 2O were gradually increased. The indexes of respiratory system and circulatory system were observed under different PEEP. The best protective pulmonary ventilation in laparoscopic surgery was obtained by EIT monitoring. PEEP value. Results in laparoscopic surgery, The best PEEP value of lung protective ventilation guided by EIT was 8 cm H _ 2O. When the PEEP value was 8 cm H _ 2O, the EIT monitoring of ROI3 and ROI4 reached the maximum. Conclusion the optimal PEEP value of lung protective ventilation for laparoscopic patients guided by EIT is 8 cm H _ 2O. The second part of the EIT guided lung protective ventilation strategy affects the lung function of patients undergoing laparoscopic surgery. Objective to investigate the effect of lung protective ventilation strategy guided by EIT on lung function in patients undergoing laparoscopic surgery. Methods the subjects who met the inclusion criteria were randomly assigned to the lung protection ventilation group (group Y) and the normal ventilation group (group N). The ventilation group was treated with low tidal volume ventilation combined with the best peep monitored by Zhang He EIT, while the normal ventilation group was treated with conventional tidal volume ventilation. The PEEP(PEEP value of Zhang He was 0 cm H _ 2O. EIT monitoring was compared between two groups under different ventilation strategies. The changes of oxygenation index and circulatory system index. Results the EIT of lung protective ventilation group (n group) and normal ventilation group (n group) were significantly lower than that of control group (P < 0. 01). The monitoring of ROI3 and ROI4 in the dorsal region of the lung after pneumoperitoneum began, and after the pneumoperitoneum ended, there was a significant difference between the two groups (P < 0. 05). EIT monitoring of roi _ 1 and ROI _ 2 in the ventral lung region after pneumoperitoneum and after pneumoperitoneum were not statistically significant (P 0.05 / T3). Conclusion the lung protective ventilation strategy guided by EIT can improve the lung function of patients undergoing laparoscopic surgery. Reduce the incidence of atelectasis in patients undergoing laparoscopic surgery and improve oxygenation function during and after operation.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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