腹腔镜手术中不同通气模式对肺功能的影响

发布时间：2018-05-09 09:48

本文选题：腹腔镜手术 + 呼吸力学　；参考：《临床麻醉学杂志》2015年07期

【摘要】：目的观察腹腔镜结直肠手术患者麻醉手术期间不同通气模式对患者呼吸功能的影响。方法选择拟行腹腔镜结直肠癌根治术患者60例,均分为肺复张组(RM组)和常规通气策略组(C组)。在麻醉诱导前(T1)、麻醉诱导后插管前(T2)、气管插管后即刻(T3)、切皮前即气腹前(T4)、气腹30min(T5)、60min(T6)、90min(T7)、120min(T8)、缝合切口时(T9)及术毕(T10)时监测肺顺应性(Comp)、PaO2、PaCO2的变化。结果与T4时比较,T5~T8时两组Comp均明显降低(P0.01),而T9时RM组Comp明显降低,C组明显降低(P0.01);与T4时比较,T8时RM组PaO2、PaCO2明显升高(P0.01);C组PaO2明显降低,但PaCO2明显升高(P0.01);且T8时RM组PaO2、PaCO2均明显高于C组(P0.01)。结论腹腔镜结直肠手术中采用小潮气量合并肺复张的通气策略有利于增加肺顺应性和氧合作用。
[Abstract]:Objective to observe the effect of different ventilation modes on respiratory function in patients undergoing laparoscopic colorectal surgery. Methods A total of 60 patients undergoing laparoscopic radical resection of colorectal cancer were divided into two groups: lung reopening group (RM group) and routine ventilation strategy group (group C). Before anesthesia induction, before intubation, immediately after tracheal intubation, before tracheal intubation, immediately after endotracheal intubation, immediately after tracheal intubation, before pneumoperitoneum T4, 30 mins before pneumoperitoneum, 90 min after pneumoperitoneum, 90 min T7, 120 min T8, at the time of suture, T9) and at the end of operation T10), the changes of Paco _ 2 and Paco _ 2 were monitored. Results compared with T4, the Comp of both groups was significantly lower than that of T4, while the Comp of RM group was significantly lower than that of T9 group, and that of P0.01T group was significantly decreased in T9 group, and that of Pao _ 2PCO _ 2 of RM group was significantly higher than that of T _ 4 group at T _ 4, and the PaO2 of RM group was significantly lower than that of T _ (8) group. However, PaCO2 was significantly higher than that in group C (P 0.01), and Pao 2 CO 2 in RM group was significantly higher than that in C group at T 8. Conclusion the ventilation strategy of low tidal volume combined with pulmonary retension is beneficial to increase lung compliance and oxygen use in laparoscopic colorectal surgery.
【作者单位】：广州中医药大学第二附属医院麻醉科;广东省佛山市第一人民医院麻醉科;
【分类号】：R614

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