呼气末正压通气在腹腔镜直肠癌手术中的应用

发布时间：2018-07-06 08:55

本文选题：呼气末正压通气 + 腹腔镜手术　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：观察腹腔镜直肠癌手术中，PEEP对血流动力学和呼吸系统的影响。方法：选取2013年6月～2014年3月于吉林大学第一医院择期行腹腔镜直肠癌手术的患者30例，ASAⅠ～Ⅲ级。按随机数字表法将30例患者随机分为2组：VCV组（n=15）和PEEP组（n=15）。患者入手术室后，连接监护仪常规监测，局麻下行桡动脉穿刺置管。静脉诱导后行气管插管（气管导管型号选择：男性ID=7.5mm；女性ID=7.0mm），连接麻醉机进行机械通气。VCV组设定潮气量（Vt）为8ml/kg，I/E为1:2，调整呼吸频率，维持PETCO235-45mmHg。PEEP组设定Vt为8ml/kg，PEEP为10cmH2O，I/E为1:2，调整呼吸频率，维持PETCO235-45mmHg。两组的Vt,，I/E，吸入新鲜气体流量在实验期间恒定不变。麻醉诱导采取仰卧位，建立人工CO2气腹，维持气腹压14mmHg；然后采取30°Trendelenburg体位；气腹停止后，恢复患者体位为仰卧位。记录患者在气腹前(T1)、Trendelenburg体位后5min（T2）、Trendelenburg体位后30min(T3)、气腹停止后5min（T4）的收缩压(SBP)，舒张压(DBP)，平均动脉压(MAP)，，心率(HR)，气道平台压（Pplat），气道峰压（Ppeak），呼吸频率（RR），氧合指数（PaO2/FiO2，OI），动态肺顺应性（Cdyn）。在以上各时间点采集桡动脉血行血气分析。结果：1，两组患者一般情况及手术情况无明显差别。2，两组SBP、DBP、MAP在T2和T3时明显高于T1（p＜0.05）；HR无明显变化。3，两组Pplat、Ppeak在T2和T3时明显高于T1（p＜0.05），两组RR在T2、T3、T4明显大于T1（p＜0.05）；两组之间Pplat、Ppeak和RR无显著性差异。4，在各时间点PEEP组OI明显高于VCV组（p＜0.05）；PEEP组患者在T2、T3、T4时Cdyn明显高于VCV组（p＜0.05）。结论：1，在腹腔镜直肠癌手术中，PEEP对血流动力学的影响不显著。2，与单纯VCV相比，在腹腔镜直肠癌手术中，PEEP可以在不影响循环稳定的同时改善动脉氧合和动态肺顺应性。
[Abstract]:Objective: To observe the effect of PEEP on hemodynamics and respiratory system in laparoscopic rectal cancer surgery.
Methods: 30 cases of laparoscopic rectal cancer surgery were selected from June 2013 to March 2014 in the No.1 Hospital of Jilin University, ASA I to grade III. 30 patients were randomly divided into 2 groups according to the random digital table method: group VCV (n=15) and group PEEP (n=15). After the patients entered the operation room, the patients were connected to the monitor routine monitoring, and the radial artery puncture was placed under local anesthesia. After venous induction, the tracheal intubation was performed (the selection of the tracheal tube: male ID=7.5mm; female ID=7.0mm). The volume of tidal gas (Vt) in the mechanical ventilation.VCV group was 8ml/kg, the I/E was 1:2, the respiratory frequency was adjusted, the Vt was 8ml/kg in the PETCO235-45mmHg.PEEP group, PEEP was 10cmH2O, and the respiratory frequency was adjusted to maintain the frequency. Hg. two groups of Vt, I/E, inhaled fresh gas flow constant during the experiment. Anesthesia induction to take the supine position, establish an artificial CO2 pneumoperitoneum, maintain the pneumoperitoneum pressure 14mmHg, and then take 30 degree Trendelenburg position, after the pneumoperitoneum stop, restore the patient's position in the supine position. Record the patient before the pneumoperitoneum (T1), Trendelenburg posture after 5min (T2), Trendele. Nburg post position 30min (T3), 5min (T4) systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), airway pressure (Pplat), airway peak pressure (Ppeak), respiratory frequency (RR), oxygenation index, dynamic pulmonary compliance.
Results: 1, the general situation and operation situation of the two groups were not significantly different.2, the two groups of SBP, DBP, MAP were obviously higher than T1 (P < 0.05) at T2 and T3; HR had no obvious changes in.3, two group Pplat. The two groups were obviously larger than those of the two (0.05); At each time point, OI in group PEEP was significantly higher than that in group VCV (P < 0.05); Cdyn in group PEEP was significantly higher than that in VCV group at T2, T3 and T4 (P < 0.05).
Conclusion: 1, in laparoscopic rectal cancer surgery, the effect of PEEP on hemodynamics is not significant.2. Compared with simple VCV, PEEP can improve arterial oxygenation and dynamic pulmonary compliance without affecting the circulation stability.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.37

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