腹腔镜宫颈癌根治术中手控和压控肺复张的应用效果

Application effect of manual or pressure-controlled ventilation lung recruitment maneuver during laparoscopic radical resection of cervical cancer

目的:分析腹腔镜宫颈癌根治术中手控和压控肺复张的应用效果。方法:选取择期行腹腔镜宫颈癌根治术的患者60例。患者均在气管插管后行容量控制模式机械通气,并分别在气腹建立后每小时末及术毕实施肺复张,其中采用手控复张30例(M组),压控复张30例(P组)。其余时间两组的通气参数一致。比较两组患者气管插管前(T0)、插管后2 min(T1)、气腹45 min(T2)、气腹90 min(T3,即第一次肺复张后30 min)、术毕(T4)、拔管后30 min(T5)时的氧合指标、呼吸力学指标。结果:两组患者手术、麻醉等一般资料比较,差异无统计学意义(P>0.05)。两组动脉氧分压(PaO2)、氧合指数(OI)、气道峰压(Ppeak)、气道平台压(Pplat)先增高,后下降(P<0.05);肺动态顺应性(Cdyn)逐渐下降,后增高(P<0.05);P组PaO2、OI、Cdyn高于M组,Ppeak、Pplat低于M组(P<0.05)。与M组比较,P组术后拔管时间缩短,低氧血症发生率降低(P<0.05);两组术后肺部并发症发生率及住院时间差异无统计学意义(P>0.05)。结论:腹腔镜宫颈癌根治术中压力控制肺复张可增加患者肺氧合能力,改善肺顺应性,降低术后低氧血症的发生率。

Aim:To compare the application effect of manual or pressure-controlled ventilation(PCV)lung recruitment maneuver during laparoscopic radical resection of cervical cancer.Methods:The data of sixty patients scheduled for selective laparoscopic radical resection of cervical cancer were collected.All patients were treated with volume-controlled ventilation after tracheal intubation,and received the lung recruitment maneuver once every 60 min starting from creation of pneumoperitoneum and the end of surgery.Thirty cases accepted manual lung recruitment maneuver(group M),and 30 cases accepted PCV(group P).The other ventilation parameters of group P remained the same as group M.At the prior to intubation(T0),2 min after intubation(T1),45 min(T2)and 90 min(T3)after creation of pneumoperitoneum,the end of surgery(T4),and 30 min after extubation(T5),the parameters of pulmonary mechanics and oxygenation of the 2 groups were compared.Results:There were no significant differences in operation and anesthesia data between the two groups(P>0.05).PaO2,OI,Ppeak,Pplat in the two groups increased firstly and then decreased with time(P<0.05);Cdyn gradually decreased and then increased(P<0.05).PaO2,OI and Cdyn in group P were higher,while Ppeak,Pplat were lower than those in group M(P<0.05).Compared with group M,the extubation time was decreased,and the rate of postoperative hypoxia was lower in group P(P<0.05).The incidence of postoperative pulmonary complications and hospital stays had no statistical differences(P>0.05).Conclusion:PCV could improve the patients′pulmonary oxygenation and compliance during laparoscopic radical resection of cervical cancer,and decrease the rate of hypoxia after extubation.