CAJ | 학술논문

目的探讨腹腔镜手术中不同CO2 气腹压力对患者围术期肺功能的影响. 方法 64 例盆腹腔恶性肿瘤患者,随机分为开腹手术组20例,低气腹压组(12 mmHg)23例和高气腹压组(15 mmHg)21例. 于麻醉前(T0)、气管插管后手术开始前(T1)、开腹(气腹)完成(T2)及开腹(气腹)30 min(T3)、60 min(T4)、120 min(T5)、手术(气腹)结束(T6)记录气道峰压(Ppeak)、气道平台压(Pplat)、胸廓顺应性(Compl)呼吸力学指标. 记录麻醉前(T0)、术后第3 天(T9)和术后第7 天(T10)用力肺活量(FVC)、一秒用力呼气容量(FEV1)、1 秒率(FEV1/FVC%)、最大呼气中期流速(MMEF)、最大通气量(MVV)肺功能指标. 结果 3组各时间点Ppeak、Pplat、Compl比较差异有统计学意义(P<0.05),高、低气腹组Ppeak、Pplat在T2 ~T5 时点显著高于开腹组(P<0.05),Compl在T2 ~T5 时点显著低于开腹组(P<0.05),而高、低气腹组间Ppeak、Pplat、Compl比较,差异无统计学意义(P>0.05). 3组各时间点FEV1%、MMEF%、MVV%比较差异有统计学意义(P<0.05). 在T9 时点FEV1%、MMEF%、MVV%开腹组显著低于高、低气腹组(P<0.05),在T10时点高、低气腹组MMEF%、MVV%高于开腹组( P<0.05). 结论腹腔镜手术中不同气腹压对患者术中呼吸力学干扰均大于开腹手术,但腹腔镜组术后肺功能恢复快,有助于预防呼吸道并发症的发生.
목적 탐토복강경수술중불동CO2 기복압력대환자위술기폐공능적영향. 방법 64 례분복강악성종류환자,수궤분위개복수술조20례,저기복압조(12 mmHg)23례화고기복압조(15 mmHg)21례. 우마취전(T0)、기관삽관후수술개시전(T1)、개복(기복)완성(T2)급개복(기복)30 min(T3)、60 min(T4)、120 min(T5)、수술(기복)결속(T6)기록기도봉압(Ppeak)、기도평태압(Pplat)、흉곽순응성(Compl)호흡역학지표. 기록마취전(T0)、술후제3 천(T9)화술후제7 천(T10)용력폐활량(FVC)、일초용력호기용량(FEV1)、1 초솔(FEV1/FVC%)、최대호기중기류속(MMEF)、최대통기량(MVV)폐공능지표. 결과 3조각시간점Ppeak、Pplat、Compl비교차이유통계학의의(P<0.05),고、저기복조Ppeak、Pplat재T2 ~T5 시점현저고우개복조(P<0.05),Compl재T2 ~T5 시점현저저우개복조(P<0.05),이고、저기복조간Ppeak、Pplat、Compl비교,차이무통계학의의(P>0.05). 3조각시간점FEV1%、MMEF%、MVV%비교차이유통계학의의(P<0.05). 재T9 시점FEV1%、MMEF%、MVV%개복조현저저우고、저기복조(P<0.05),재T10시점고、저기복조MMEF%、MVV%고우개복조( P<0.05). 결론 복강경수술중불동기복압대환자술중호흡역학간우균대우개복수술,단복강경조술후폐공능회복쾌,유조우예방호흡도병발증적발생.
Objective To investigate the effects of different CO2 pneumoperitoneum pressures on perioperative pulmonary function in laparoscopic operations.Methods Sixty-four patients with malignant pelvis/abdominal tumor were randomly divided into open group(n=20), low pneumoperitoneum pressure group ( 12 mmHg, n =23 ) and high pneumoperitoneum pressure group ( 15 mmHg, n =21 ) .The peak airway pressure(Ppeak),airway plateau pressure(Pplat) and thoracic compliance(Compl) were recorded at the following time points, before anesthesia( T0 ) ,after tracheal intubation but before operation( T1 ) ,when the abdominal open( pneumoperitoneum) completed( T2 ) , 30,60 and 120 minutes after the abdominal open(pneumoperitoneum)(T3,T4 and T5,respectively),and when the operation(pneumoperitoneum) finished(T6).The forced vital capacity(FVC),forced expiratory volume in one second(FEV1),forced vital capacity rate of one second (FEV1/FVC%),maximum mid-expiratory flow rate(MMEF) and maximum voluntary ventilation(MVV) were recorded at T0,the third day after operation( T9 ) and the seventh day after operation( T10 ) ,respectively.Results There were significant differences in Ppeak,Pplat and Compl at all time points among three groups(P<0.05).From T2 to T5,low and high pneumoperitoneum pressure groups obtained significantly higher Ppeak and Pplat but significantly lower Compl compared to open group (P<0.05).There were no significant differences in Ppeak,Pplat or Compl between low pneumoperitoneum pressure group and high pneumoperitoneum pressure group( P>0.05) .There were significant differences in FEV1%,MMEF% and MVV% at all time points among three groups (P<0.05).At T9,FEV1%,MMEF% and MVV%in the open group were significantly lower than those in the low or high pneumoperitoneum pressure group ( P<0.05 ) .At T10 , MMEF%and MVV%in the low or high pneumoperitoneum pressure group were higher than those in the open group(P<0.05).Conclusion Compared with open surgery, laparoscopic surgery with different pneumoperitoneums can affect the patients′respiratory system more significantly,with rapid recovery of pulmonary function after laparoscopic surgery,and it is helpful for the prevention of respiratory complications.