肥胖患者行妇科腹腔镜手术时的机械通气策略

The mechanical ventilation strategies in obese patients undergoing gynecological laparoscopic surgery

目的探讨肥胖患者行妇科腹腔镜手术时采用不同的机械通气参数组合来获得较低气道压力同时又能维持良好通气的肺保护策略。方法选择期行妇科腹腔镜手术的肥胖患者40例(30 kg/m2≤BMI<40 kg/m2),随机分为A组(潮气量8 mL/kg,呼吸频率12次/min,吸呼比为1∶2.0)和B组(潮气量6 mL/kg,呼吸频率16次/min,吸呼比1∶1.5)。2组均采用静吸复合全身麻醉,分别于气管插管后、手术前、CO2气腹后、行T位后3 min、T位后10 min、T位后30 min记录气道峰压、气道平台压,计算动态肺顺应性、PETCO2值,于各观测时点抽取动脉血行血气检测。结果 A组气道峰压、气道平台压均高于B组,B组动态肺顺应性优于A组;2组患者观察期间PETCO2、p(O2)、p(CO2)均无显著性差异。结论肥胖患者行妇科腹腔镜手术,96 mL/kg的分钟通气量可以较好地满足患者机体的需要,且无高碳酸血症的发生;潮气量6 mL/kg,呼吸频率16次/min,吸呼比1∶1.5的通气组合可以获得较低的气道压力,同时又能维持良好的通气,从而减少高气压肺损伤的发生,值得临床推广。

Objective It is to explore the methods in obese patients who underwent laparoscopic gynecological operation with different mechanical ventilation parameters to obtain lower airway pressure mechanical ventilation and maintain good lung protective strategies of ventilation.Methods 40 cases of elective obese patients（30 kg/m^2≤BMI40 kg/m^2） who undergoing gynecological laparoscopic surgery were randomly divided into group A（Vt=8 mL/kg,RR=12/min,I：E=1：2.0） and group B（Vt= 6 mL/min,RR=16/ min,I：E=1：1.5）.Both groups were treated with inhalation-intravenous general anesthesia.Peak airway pressure（PIP）,plateau airway pressure（Pplat） were recorded,and dynamic lung compliance（Clt） and PETCO2 were calculated respectively after tracheal intubation before operation（t0）,after CO2 pneumoperitoneum（t1）,after Trendelenburg position three minutes（t2）,after Trendelenburg position ten minutes（t3）,after Trendelenburg position thirty minutes（t4）.Artery blood was extracted for blood gas testing on every observation.Results In group A the peak airway pressure and plateau airway pressure were higher than thant in group B,in group B dynamic lung compliance was better than that in group A.The PETCO2,p（O2）,p（CO2） has no significant difference between two groups during observation.Conclusion 96 mL/kg minute ventilation can better meet the needs of organisms without hypercapnia occurrence when obese patients underwent gynecological laparoscopic surgery,the ventilation（Vt= 6 mL/min,RR=16/min,I：E=1：1.5）can obtain lower airway pressure while maintaining good ventilation,thereby reducing high pressure pulmonary injuries,it is worth clinical application.