头低臀高体位下行妇科腹腔镜手术时七氟烷对呼吸力学的影响

Sevoflurane Influence on Respiratory Mechanics under Trendelenburg Position for Gynecology Laparoscopic Surgery

目的:观察头低臀高体位下行妇科腹腔镜手术时七氟烷吸入麻醉对呼吸力学的影响。方法:选择妇科腹腔镜择期手术患者150例,随机分为七氟烷组、异氟烷组。七氟烷组患者在气管插管全麻下选用七氟烷持续吸入维持麻醉;异氟烷组患者在气管插管全麻下选用异氟烷持续吸入维持麻醉,2组患者术中连续测定气道峰压力、平台压、胸肺顺应性、呼气末CO2分压等指标,分别在插管后5min、气腹后5min、头低臀高位后5min和30min、改平卧位后以及拔管前6个时间点记录相关观察指标的变化。结果:七氟烷组与异氟烷组在头低位5min和头低位30min时的气道峰压力、平台压比较均有显著差异(P<0.01);2组胸肺顺应性变化在头低位改平卧后差异有统计学意义(P<0.05)。2组呼气末CO2分压则随着气腹、头低位、改平卧位呈显著变化,但2组之间差异无统计学意义(P>0.05)。结论:七氟烷对患者呼吸力学的影响比异氟烷轻,尤以头低位明显,而且停止吸入麻醉药后七氟烷组呼吸力学指标恢复比异氟烷组快,七氟烷吸入麻醉更适用于头低臀高体位下妇科腹腔镜手术。

Objective：To study the effect of sevoflurane inhaled anesthesia on respiratory mechanics for patients undergoing laparoscopic surgery in Trendelenburg position.Methods： A total of 150 patients who were planed to receive gynecology laparoscopic surgery were enrolled.All participants were randomized either into Group A（n=75）or into Group B（n=75）.Patients in Group A were given intubation general anesthesia continue inhaled sevoflurane to maintain anesthesia,while patients in Group B were given inhaled isofluorane to maintain anesthesia.Airway peak pressure（Peak）,platform pressure（Plat）,chest pulmonary compliance,and PET CO2 were investigated at 5 min after tracheal intubation,5 min after abdominal CO2 insufflation,5 min and 30 min after trendelenburg position,5 min after returning peripharyngeal and 5 min before detubation,respectively.Results： Peak changed significantly between the two groups both at 5 min and 30 min after Trendelenburg position.The Plat also changed in both groups,there were significantly statistical significances（P0.01）.Pulmonary compliance changed of two groups at 5 min after returning peripharyngeal（P0.05）.There were obvious changes of PET CO2 with abdominal CO2 insufflations,Trendelenburg position and returning peripharyngeal,but changes between two groups were not statistically significant（P0.05）.Conclusions： Sevoflurane inhaled anesthesia effect on respiratory mechanics of laparoscopic patients is light,especially at trendelenburg position.Breathing mechanics indexes recovery after stopping inhaled anesthesia of sevoflurane group is fast than that of isofluorane group.Sevoflurane inhalant anesthetics is more suitable for gynecological laparoscopic surgery under Trendelenburg postures.