肺保护性通气策略在妇科腹腔镜手术中应用的临床观察

发布时间：2018-06-04 18:28

本文选题：肺保护性通气策略 + 肺损伤　；参考：《实用妇产科杂志》2017年07期

【摘要】：目的:通过监测肺顺应性、氧合指数、血浆白细胞介素-8(IL-8)值、血浆克拉拉细胞蛋白(CC16)值等指标,观察肺保护性通气策略是否可以改善妇科腹腔镜手术患者呼吸功能,降低肺损伤的发生。方法:选择40例美国麻醉医师协会体格情况评估分级(ASA分级)Ⅰ~Ⅱ级行择期腹腔镜宫颈癌根治术患者,采用随机数字表法将40例受试者分为两组。在全麻机械通气中,A组采用传统间歇正压通气模式,潮气量设置为10 ml/kg[理想体质量(PBW)];B组采用肺保护性通气策略,潮气量设置为6 ml/kg(PBW)+5 cm H_2O呼气末正压通气(PEEP)+手法肺复张。对患者气腹前(T_0)、气腹后2小时(T_1)、气腹后4小时(T_2)的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、呼吸频率(RR)、肺顺应性(C)进行观察;于T_0、T_1、T_2、手术后2小时(T_3)、手术后24小时(T_4)抽取血气,计算氧合指数(OI)值;分别在T_0、T_1、T_2、T_3、T_4抽取静脉血,检测血浆IL-8、血浆CC16值。结果:T_0时两组患者C比较,差异有统计学意义(P0.05);两组内T_1、T_2时点与T_0时比较,C均下降,差异有统计学意义(P0.05),A组下降均较B组明显(P0.05)。两组患者OI值在T_0、T_1、T_3、T_4时间点,差异有统计学意义(P0.05)。两组患者血浆IL-8、CC16值在T_1、T_2、T_3、T_4时点,差异有统计学意义(P0.05)。结论:肺保护性通气策略可能改善妇科腹腔镜手术患者呼吸功能,降低肺损伤的发生。
[Abstract]:Objective: to observe whether lung protective ventilation strategy can improve respiratory function of patients undergoing gynecological laparoscopic surgery by monitoring lung compliance, oxygenation index, plasma interleukin-8 IL-8 and plasma Clara cell protein CC16. Reduce the incidence of lung injury. Methods: a total of 40 patients with elective laparoscopic radical cervical cancer surgery were selected and randomly divided into two groups. In general anesthesia mechanical ventilation, the conventional intermittent positive pressure ventilation mode was used in group A, the tidal volume was set at 10 ml/kg [ideal body mass (PBW)] and lung protective ventilation strategy was adopted in group B, and the tidal volume was set at 6 ml / kg PBW) 5 cm H2O end expiratory pressure (PEEP). The mean arterial pressure (MAPP), heart rate (HRT), central venous pressure (CVP), respiratory rate (RRN), lung compliance C (C) of patients were observed before pneumoperitoneum, 2 hours after pneumoperitoneum, 4 hours after pneumoperitoneum and 4 hours after pneumoperitoneum. Blood gas was extracted at T0T1T2, 2 hours after operation, and 24 hours after operation. The value of oxygen index (OI) was calculated, and the venous blood was collected from T0 / T _ (1) / T _ (2) / T _ (2) / T _ (3) / T _ 4 to detect the levels of plasma IL-8 and plasma CC16 respectively. Results there was a significant difference in C between the two groups at 1: T0, the difference was statistically significant (P 0.05), and the decrease of C in group A was significantly lower than that in group B at the time point of T _ 1 / T _ 2 and T _ 0 / T _ 0, and there was a significant difference between group A and B (P < 0.05). The OI value of the two groups was significantly different at the time point of T _ S _ 0 / T _ 1 / T _ S _ 3 / T _ 4 (P < 0.05). The level of IL-8 CC16 in plasma of the two groups was significantly different at the time point of T _ 1 / T _ 2 / T _ 3 / T _ 4 (P 0.05). Conclusion: lung protective ventilation strategy may improve respiratory function and reduce lung injury in patients undergoing gynecologic laparoscopic surgery.
【作者单位】：沈阳市妇婴医院麻醉科;
【基金】：沈阳市卫计委科研基金资助项目(编号:2015-06)
【分类号】：R614

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