全身麻醉诱导期呼气末正压通气对子宫肌瘤患者腹腔镜术后呼吸功能的影响

发布时间：2018-08-22 20:22

【摘要】：目的探究全身麻醉(全麻)诱导期呼气末正压通气对子宫肌瘤患者腹腔镜术后呼吸功能的影响。方法选择该院2011年1月 2014年1月收治腹腔镜下行子宫切除术的子宫肌瘤患者200例,将患者分为对照组和观察组,对照组患者在手术过程中采用呼气末正压通气(PEEP),观察组患者在手术中麻醉诱导期开始便加用呼气末正压通气(PEEP)。观察并记录两组患者在围术期血流动力学参数、呼吸参数、动脉血气变化并计算呼吸系统顺应性。结果观察组患者在气腹30 min、气腹60 min、气腹90 min及放气时的动脉与呼气末二氧化碳分压差值(Pa-ETCO_2),水平均显著低于气腹完成时,且各水平与对照组同期水平相比较,均P0.05;观察组患者气腹30 min、气腹60 min、气腹90 min及放气时的肺泡动态顺应性显著高于对照组同期水平,P0.05;观察组患者在气腹60 min、气腹90 min及放气时的氧合指数(OI)与对照组比较差异有统计学意义,P0.05。结论全麻诱导期呼气末正压通气对子宫肌瘤患者全身麻醉术后发生低氧血症和高二氧化碳血症有很好的预防作用,减少肺不张的发生率,具有较好临床效果,值得在临床上推广使用。
[Abstract]:Objective to investigate the effect of positive end-expiratory pressure on respiratory function in patients with hysteromyoma during induction of general anesthesia (general anesthesia). Methods from January 2011 to January 2014, 200 patients with hysteromyoma underwent laparoscopic hysterectomy were selected and divided into control group and observation group. The patients in the control group were treated with positive end-expiratory pressure ventilation (PEEP),) during operation, and the patients in the observation group received positive end-expiratory pressure ventilation (PEEP).) at the beginning of anesthesia induction period during operation. The hemodynamic parameters, respiratory parameters, arterial blood gas changes and respiratory compliance were observed and recorded in the two groups during perioperative period. Results the difference of arterial and end-expiratory carbon dioxide pressure (Pa-ETCO_2) during pneumoperitoneum 30 minutes, pneumoperitoneum 60 minutes, pneumoperitoneum 90 min and exhalation was significantly lower in the observation group than at the time of pneumoperitoneum, and the levels were compared with those in the control group. The dynamic compliance of pneumoperitoneum, pneumoperitoneum and pneumoperitoneum in the observation group was significantly higher than that in the control group at 30 minutes, 60 minutes and 90 min, respectively, and the dynamic compliance of alveoli in the observation group was significantly higher than that in the control group (P 0.05). The difference between the two groups was statistically significant (P 0.05). Conclusion positive end-expiratory pressure ventilation during induction of general anesthesia has a good preventive effect on hypoxemia and hypercapnia in patients with uterine leiomyoma after general anesthesia, and can reduce the incidence of atelectasis. It is worth popularizing in clinic.
【作者单位】：广东省东莞市虎门医院麻醉科;广东省东莞市虎门医院妇产科;
【分类号】：R614.2;R737.33

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