腹腔镜胆囊切除术气腹对呼吸力学的影响及其呼吸参数的调整

Effects of pneumoperitoneum on respiratory mechanics during laparoscopic cholecystectomy and adjusting ventilation parameters

目的观察腹腔镜下行胆囊切除手术期间的呼吸力学变化,为术中麻醉呼吸管理提供依据。方法选腹腔镜下行胆囊切除术的择期手术病人20例,ASAⅠ-Ⅱ级。全部病例采用全身麻醉,呼吸参数设定:潮气量(VT)=体重×10mL;呼吸频率(RR)=12次/min;调整后的呼吸参数:VT=体重×6、7mL;RR=16￣20次/min。维持调整前、后的呼气末二氧化碳分压(PETCO)在35￣45mmHg之间。用Datex气体监测仪测定麻醉诱导2后5min、气腹前5min、气腹后5min、调整呼吸参数后5min及放气后5min的Paw、肺顺应性(CL)和PETCO。2用SPSS11.5统计学软件进行分析、处理。结果在分时通气量不变的情况下,气腹5min后Paw明显增加,CL下降;调整呼吸参数后,呼吸力学指标明显改善,放气后恢复至气腹前水平。结论腹腔镜下行胆囊切除手术,气腹影响肺通气,致使Paw增高,CL下降。通过调整呼吸参数,使呼吸力学指标明显改善。因此,腹腔镜下行胆囊切除手术,应注意术中呼吸管理。

To measure the changes in respiratory mechanics and administrate respiration during laparoscopic cholecystectomy in patients. 20 patients undergoing laparoscopic cholecystectomy under general anaesthesia and controlled ventilation were selected. Ventilation parameters (tidal volume=body weight × 10 mL, respiratory rate 12 times/min) before operation were set. After pneumoperitoneum, ventilation parameters (tidal volume: body weight × 6~7 mL, respiratory rate 16~20 times/min) were adjusted. PETCO2 were maintained between 35 and 45 mmHg. Airway pressure, compliance of lung and PETCO2 were monitored with Datex gas monitor. Measurements were done at 5 distinct phases: five minutes after the induction of anesthesia; five minutes before pneumoperitoneum; five minutes after pneumoperitoneum; five minutes after adjusting ventilation parameters; five minutes after the peritoneal deflation. Respiratory mechanics were analysed using SPSS 11.5 statistics software. When compared to preinsufflation values, airway pressure after abdominal insufflation became a significant increase in airway pressures (16%) at constant tidal volume and respiratory frequency. And compliance of lung became a significant decrease from (39.85±11.22) mL/cmH2O to (27.29±5.79) mL/cmH2O. After adjusted ventilation parameters, airway pressure had a significant improvement. Respiratory mechanics returned to baseline values after abdominal deflation. [Conclusion] After CO2 insufflation, high intraabdominal pressures results in significant increase of airway pressure and decrease of compliance. Therefore, we should pay attention to respiratory manage and adjusting ventilation parameters during laparoscopic cholecystectomy.