全身麻醉妇科腹腔镜手术中呼吸频率和潮气量研究

Research of Breathing Frequency and Tidal Volume during the Gynecological Laparoscopic Operation under General Anaesthesia

目的探讨全身麻醉(全麻)下妇科腹腔镜手术患者在CO2气腹及Trendelenburg(屈氏)体位后合适的呼吸频率(f)和潮气量(Vt)。方法将80例ASAⅠ～Ⅱ级的患者随机分为4组:A、B、C、D组,全麻插管后机控呼吸。气腹前4组均采用Vt 10 ml/kg,f 10/min。气腹及屈氏体位后A组Vt及f不变,B、C、D组Vt改为8 ml/kg,f分别改为14/min、16/min、18/min,记录患者气腹前和气腹及屈氏体位20 min后的平均动脉压(MAP)、心率(HR)及呼气末二氧化碳分压(PETCO2)、气道压力峰值(PEAK)。结果气腹及屈氏位20 min后,4组患者MAP、HR、PEAK值均较前显著升高,A组PEAK值最高;A、B、C组PETCO2值均较前显著升高且A组和B组显著高于C组,而D组PETCO2值较前显著降低。结论气腹及屈氏体位后采用8 ml/kg的Vt和16/min的f较适合全麻妇科腹腔镜手术。

Objective To discuss the suitable breath frequency and tidal volume after CO2 pneumoperitoneum and Trendelenburg position during gynecological [aparoscoplc operation under general anesthesia. Methods Eighty cases of ASA with grade I-Ⅱ were randomly divided into four groups （Group A, B, C and D）. After general anaesthesia intubation breath frequency was set at 10 time/win, tidal volume 10 ml/kg before pneumoperitoneum. After CO2 pneumoperitoneum and Trendelenburg position, the breath frequency and tidal volume of group A were similar, while in group B, C and D they were adjusted to 14, 16 and 18 time/rain respectively with tidal volume 8 ml/kg. The mean arterial pressure （MAP）, heart rate （HR）, end tidal carbon dioxide partial pressure （PETCO2 ） and peak inflation pressure （PEAK） before and 20 win after COz pneumoperitoneum and Trendelenburg position were recorded. Results The MAP, HR and PEAK of all groups were significantly increased after CO2 pneumoperitoneum and Trendelenburg position. The peak in group A was the highest; The PETCO2 in group A, B and C were significantly increased after CO2 pneumoperitoneum and Trendelenburg position; The PETCO2 in group A and B were signif- icantly higher than that of group C, while the PETCO2 in group D descended significantly. Conclusion It is suggest that it may be a better approach to adopt breath frequency 16 time/win and tidal volume 8 ml/kg after CO2 pneumoperitoneum and Trendelenburg position during the procedure of gynecological laparoscopic operation under general anaesthesia.