全麻腹腔镜胃癌根治术中应用小潮气量联合低水平呼气末正压通气对老年患者呼吸功能的影响

The influence of small tidal volume combined with low level of positive end expiratory pressure for respiratory function of aged patients who underwent laparoscopic radical gastrectomy under general anesthesia

目的:观察全身麻醉腹腔镜胃癌根治术中应用小潮气量(tidal volume,VT)联合低水平呼气末正压通气(positive end expiratory pressure,PEEP)对老年患者呼吸功能的影响。方法:将34例ASA I或II级腹腔镜胃癌根治术老年患者分为A、B两组。A组:机械通气模式为间歇正压通气(intermittent positive pressure ventilation,IPPV)加5cm H2O PEEP,VT=6ml/kg,f=16次/min;B组:机械通气模式为IPPV,VT=9ml/kg,f=12次/min。观察术前(T1)、麻醉插管后30min(T2)、拔管后15min(T3)的动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、呼气末二氧化碳分压(PETCO2)、肺泡-动脉氧分压差(A-aDO2)、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)及术中的气道峰压(peak airway pressure,Ppeak)。结果:T3时,A组PaO2明显高于B组(P<0.05),A组A-aDO2明显低于B组(P<0.05)。其他各时点A、B两组PaO2、PaCO2、PETCO2、A-aDO2、MAP、CVP、Ppeak组间比较差异无统计学意义(P>0.05)。结论:腹腔镜胃癌根治术中应用小VT联合低水平PEEP通气能有效改善老年患者术后低氧血症,减少肺部并发症,有利于老年患者呼吸功能的恢复,对血流动力学无明显影响,是老年患者腹腔镜上腹部手术全麻安全、有效的通气方法。

Objective ： To investigate the influence of small tidal volume combined with low level of positive end expiratory pressure （PEEP） for respiratory function of aged patients who underwent laparoscopic radical gastrectomy under general anesthesia. Methods ： Thirty-four aged patients in ASA I or II who were performed laparoscopic radical gastrectomy were divided into two groups. The mechanical ventilation of group A was intermittent positive pressure ventilation （IPPV） plus 5cm H2O PEEP, tidal volume （VT） = 6ml/kg, frequency（f） = 16bpm. The mechanical ventilation of group B was IPPV, tidal volume （VT） = 9ml/kg, f = 12bpm. The PaO2, PaCO2 , PETCO2, A-aDO2, mean arterial pressure（MAP） and central venous pressure （CVP） were observed at the time points of before operation（ T1 ） ,30rain after tracheal intubation （ T2 ） and 15min after tracheal extubation （ T3 ）. Peak airway pressure （Ppeak） was recorded during operations. Results ： In T3 , PaO2 of group A was significantly higher than that of group B （ P 〈 0. 05 ）, A-aDO2 of group A was significantly lower than that of group B （ P 〈 0.05 ）. In other time points, the difference of PaO2, PaCO2, PETCO2 , A-aDO2, MAP, CVP and Ppeak between two groups was not significant （ P 〉 0.05 ）. Conclusions ： Small tidal volume combined with low level of PEEP in laparoscopic radical gastrectomy can improve the postoperative hyoxemia of old patients and decrease complications of lung. It is beneficial to recovery of respiratory function, and doesnt affect hemodynamics obviously. It is a safe and effective method of ventilation for aged patients who will accept laparoscopic upper abdominal surgery under general anesthesia.