腹腔镜胆囊切除术中气腹压对COPD患者呼吸力学的影响

The Effect of Intra-abdominal Pressure on Pneodynamic in the Patients with COPD Undergoing Laparoscopic Cholecystectomy

目的探讨不同气腹压时慢性阻塞性肺部疾病 (COPD)患者呼吸动力学的变化。方法筛选出轻中度COPD患者 16例 ,在气管插管全麻机械通气下行腹腔镜胆囊切除术 ,监测术中 2个时期 (气腹 15min和 6 0min) 3种CO2 气腹压 (1.1、1.6和 2 .1kPa)条件下的气道峰压、平台压和胸肺顺应性等呼吸力学指标。结果气腹压与气道压的变化正相关 ,与顺应性负相关 ,当气腹压达 2 .1kPa时 ,各呼吸指标改变更显著 ,气道压各值明显高于气腹压为1.1和 1.6kPa时的各值 (p <0 .0 1,0 .0 5 ) ;气道压随气腹时间的进行轻度上升 (p >0 .0 5 ) ,当气腹压 2 .1kPa、气腹6 0min时胸肺顺应性下降显著 (p <0 .0 5 )。 结论气腹对呼吸力学的影响随气腹压力的增加而明显 ,对于COPD患者术中控制气腹压有重要意义。

Objective To observe the effect of different intra -a bdominal pressure ( IAP ) on pneodynamic in the patients with chronic obstructiv e pulmonary disease (COPD) during the laparoscopic cholecystectomy. Met hods 16 patients having COPD underwent laparoscopic cholecystectomy wit h general anesthesia in mechanical ventilation,and the pneodynamic indexes(peak and platform pressure of airway and chest-lung compliance) were monitored at 15 th and 60th minute after beginning of operation under three pictures of IAP (1.1 , 1.6, 2.1 kPa) of CO 2 pneumoperitoneum. Results There was positive correlation between IAP and pressure of airway but negative correlation between IAP and chest-lung compliance. When IAP reached 2.1kPa, the parameters of pneodynamic had more significant change, and the pressure of airway was mark edly higher than that in 1.1 and 1.6kPa IAP(p<0.01, 0.05); the compliance had more significant descent at 60th minute. Conclusion The higher IAP increases, the more significant pneumoperitoneum-effect on pneodynamic.It is important to control the IAP of the patients having COPD in operation.