摘要
目的观察不同通气策略对腹腔镜手术病人呼吸力学及氧代谢情况的影响。方法25例ASAⅠ—Ⅱ级全麻下择期腹腔镜手术患者随机分为三组，麻醉诱导药物相同，气腹前呼吸机参数均为VT=8ml／kg，F=15次／min，I：E=1：2。气腹后，A组：VT=10ml／kg，F=12次／min，I：E=1：3；B组：VT=6ml／kg，F=20次／min，I：E=1：2；C组参数设定同气腹前。记录气腹前后潮气量VT，气道峰压Pmax，气道平台压Plat，气道阻力Raw，分别计算胸肺静态顺应性Cst，动态顺应性Cdyn；测定气腹前后混合静脉血和动脉血血气，计算各组气腹前后肺泡气动脉血氧分压差[P（A—a）O2]及氧摄取率（ERO2）。结果A组气腹前后Cst无差异（P〉0．05），而B、C组气腹后Cst减小，且明显小于A组（P〈0．01）；三组气腹后Cdyn均明显减小（P〈0．01）。气腹后A、C组的P（A—a）O2较气腹前升高（P〈0．05），ERO2较气腹前下降（P〈0．05）。以上各指标组间比较差异无显著性（P〈0．05）。结论气腹后三种通气策略下胸肺动态顺应性均减小，P（A-a）O2及ERO2组间相比无差异。不能肯定何种通气策略更具优势。
Objective To investigate the effects of different mechanical ventilation methods on respiratory mechanics and oxygenation in patients undergoing laparoscopy. Methods twenty five patients for selective laparoscopy requiring general anesthesia ,ASA Ⅰ-Ⅱ,were randomly divided into three groups according to the mechanical ventilation method. Anesthesia was induced with midazolam （0. 1mg/kg） and etomidate （0.2 mg/kg）,vecuronium （0.1 mg/kg）,fentanyl （3 -4 μg/kg）.After intracheal intubation,ventilator parameters were VT=8ml/kg, F=15/min, I：E=1：2.After pneumoperitoneum, ventilator parameters were different：VT=10ml/kg, F= 12/min, I：E= 1：3 in group A;VT=6ml/kg, F=20/min, I：E=1：2 in group B; VT=8ml/kg, F=15/min I：E=1：2 in group C .To observe VT,Pmax,Plat ,Raw at the time before pneumoperitoneum （T1） and 35 rain after pneumoperitoneum （T2）. Arterial and mixed venous blood samples were taken at T1 and T2 for analysis.P（A-a）O2,extraction rate of oxygen（ERO2） were calculated. Results Cst were decreased in group B and Cafter pneumoperitoneum （ P〈0.05 ） ,they were significantly decreased compared with that in group A （ P〈0.01 ） .Cdyn in all 3 groups were significantly decrease after pneumoperitoneum （ P〈0.01 ） .P（A-a）O2 were increased after pneumoperitoneum in group A and C（P〈0.05）,but ERO2 were decreased （P〈0.05）.No significant difference was found in the indexes above among the three group （P〉0.05）. Conclusion Cdyn is significantly decreased when one of the three different mechanical ventilation methods is adopted after pneumoperitoneum. It is not sure to determine which mechanical ventilation method is more suitable for patients undergoing laparoscopy.
出处
《微创医学》
2006年第1X期6-9,共4页
Journal of Minimally Invasive Medicine
关键词
腹腔镜
气腹
二氧化碳
肺通气
呼吸力学
氧合
Laparoscopy
Pneumoperitoneum
Carbon dioxide
Lung ventilation
Respiratory mechanics
Oxygenation
