中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
6期
730-732
,共3页
呼吸,人工%气腹,人工%呼吸功能试验%肥胖症
呼吸,人工%氣腹,人工%呼吸功能試驗%肥胖癥
호흡,인공%기복,인공%호흡공능시험%비반증
Respiration,artificial%Pneumoperitoneum,artificial%Respiratory function tests%Obesity
目的 评价反比通气(I:E=1:1)对肥胖患者腹腔镜手术气腹时肺通气功能的影响.方法 择期行腹腔镜直肠癌根治术患者60例,年龄30 ～ 64岁,ASA分级Ⅰ或Ⅱ级,BMI 30 ～ 40 kg/m2.采用随机数字表法,将其分为2组(n=30),A组:气腹后接受I∶E=1∶1通气模式,B组,气腹后接受1∶E=1∶2通气模式.于气管插管后即刻、气腹开始后30、60和120 min时记录PaO2、PaCO2、吸气峰压(PIP)、平均气道压(Pmean)、肺动态顺应性(Cdyn)、肺内分流率(Qs/Qt)、呼气末二氧化碳分压(PEr CO2)、RR、MAP和HR.结果 与B组比较,A组PaO2、Pmean和Cdyn升高,PIP、Qs/Qt降低(P＜0.05或0.01),RR、PEr CO2、PaCO2和血流动力学指标差异无统计学意义(P＞0.05).结论 反比通气(I:E=1:1)可有效改善肥胖患者腹腔镜手术气腹时肺通气功能,且对血流动力学无明显影响.
目的 評價反比通氣(I:E=1:1)對肥胖患者腹腔鏡手術氣腹時肺通氣功能的影響.方法 擇期行腹腔鏡直腸癌根治術患者60例,年齡30 ～ 64歲,ASA分級Ⅰ或Ⅱ級,BMI 30 ～ 40 kg/m2.採用隨機數字錶法,將其分為2組(n=30),A組:氣腹後接受I∶E=1∶1通氣模式,B組,氣腹後接受1∶E=1∶2通氣模式.于氣管插管後即刻、氣腹開始後30、60和120 min時記錄PaO2、PaCO2、吸氣峰壓(PIP)、平均氣道壓(Pmean)、肺動態順應性(Cdyn)、肺內分流率(Qs/Qt)、呼氣末二氧化碳分壓(PEr CO2)、RR、MAP和HR.結果 與B組比較,A組PaO2、Pmean和Cdyn升高,PIP、Qs/Qt降低(P＜0.05或0.01),RR、PEr CO2、PaCO2和血流動力學指標差異無統計學意義(P＞0.05).結論 反比通氣(I:E=1:1)可有效改善肥胖患者腹腔鏡手術氣腹時肺通氣功能,且對血流動力學無明顯影響.
목적 평개반비통기(I:E=1:1)대비반환자복강경수술기복시폐통기공능적영향.방법 택기행복강경직장암근치술환자60례,년령30 ～ 64세,ASA분급Ⅰ혹Ⅱ급,BMI 30 ～ 40 kg/m2.채용수궤수자표법,장기분위2조(n=30),A조:기복후접수I∶E=1∶1통기모식,B조,기복후접수1∶E=1∶2통기모식.우기관삽관후즉각、기복개시후30、60화120 min시기록PaO2、PaCO2、흡기봉압(PIP)、평균기도압(Pmean)、폐동태순응성(Cdyn)、폐내분류솔(Qs/Qt)、호기말이양화탄분압(PEr CO2)、RR、MAP화HR.결과 여B조비교,A조PaO2、Pmean화Cdyn승고,PIP、Qs/Qt강저(P＜0.05혹0.01),RR、PEr CO2、PaCO2화혈류동역학지표차이무통계학의의(P＞0.05).결론 반비통기(I:E=1:1)가유효개선비반환자복강경수술기복시폐통기공능,차대혈류동역학무명현영향.
Objective To evaluate the effect of inverse ratio ventilation (I ∶ E =1 ∶ 1) on ventilatory function during pneumoperitoneum in the obese patients undergoing laparoscopic surgery.Methods Sixty patients,aged 30-64 yr,of ASA physical status Ⅰ or Ⅱ],with body mass index of 30-40 kg/m2,scheduled for elective laparoscopic radical resection of rectal carcinoma,were divided into 2 groups (n =30 each) using a random number table:I∶E =1∶1 mode of ventilation after pneumoperitoneum (group A),and I∶E =1∶2 mode of ventilation after pneumoperitoneum (group B).Anesthesia was induced with midazolam,fentanyl,propofol and vecuronium.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with infusion of propofol and remifentanil,sevoflurane inhalation,and intermittent iv boluses of vecuronium.In group A,the patients received I ∶ E =1 ∶ 1 after pneumoperitoneum.In group B,the patients received I ∶ E =1 ∶ 2.PaO2,PaCO2,peak inspiratory pressure (PIP),mean airway pressure (Pmean),dynamic compliance (Cdyn),intrapulmonary shunt (Qs/Qt),PETCO2,RR,MAP and HR were recorded immediately after intubation,and at 30,60 and 120 min of pneumoperitoneum.Results Compared with group B,PaO2,Pmean and Cdyn were significantly increased,and PIP and Qs/Qt were decreased,and no significant changes were found in RR,PET CO2,PaCO2 and hemodynamic parameters in group A.Conclusion Inverse ratio ventilation (I ∶ E =1 ∶ 1) can effectively improve ventilatory function during pneumoperitoneum in the obese patients undergoing laparoscopic surgery without exerting adverse effects on hemodynamics.
