反比通气对超体重患者妇科腹腔镜手术中呼吸功能的影响

Efects of Inverse Ratio Ventilation( IRV) on Respiratory Function in Overweight Patients Undergoing Gynecologic Laparoscopic Surgery.

目的探讨反比通气在妇科腹腔镜手术中对超体重患者呼吸功能的影响。方法将80例患者按随机数字表法分为对照组与实验组,每组40例,建立CO2气腹时,实验组采用反比通气,吸呼比为2∶1,对照组吸呼比为1∶2,潮气量,呼吸频率不变,观察记录麻醉前5min(T0)、气腹开始前2min(T1)、气腹后60min(T2)及气腹解除后5min(T3)不同时刻的血流动力学指标、呼吸道压力、呼吸道压力峰值(Ppeak)、呼吸末二氧化碳分压(P ET CO2),同时测量气腹前2min,气腹后60min的动脉血气。结果反比通气能明显降低气道压峰值,提高动脉血氧分压(PaO2),但动脉血二氧化碳的分压(PaCO2)和PH与对照组比较无统计学差异(P>0.05)。结论反比通气在妇科腹腔镜手术中优于常规通气模式,能有效降低腹腔镜手术中高气道压峰值,减少并发症。

Objective To investigate the efects of inverse ratio ventilation （IRV） on respiratory function in overweight patients un- dergoing gynecologic laparoscopic surgery. Methods Eighty overweight patients undergoing gynecological laparoscopic surgery were ran- domly divided into IRV and control group（ n = 40 ）. Patients were all implemented into the program of general anesthesia, and ventilated with diferent modes. End - tidal carbon dioxide partial pressure （ PET CO2 ） was maintained between 35 - 50mmHg. Arterial blood was col- lected respectively to analyze blood gas at 2 rain before the start of pneumoperitoneum （ T1 ） , 60 min after the start of pneumoperitoneum （ T2 ）. Meanwhile,parameters of hemodynamics and respiratory mechanics were monitored and calculated. Results At T2 , Ppeak was sig- nificantly lower （ P 〈 0.05 ） and PaO2 （ 533.67 ± 47.43 ） were significantly higher in the IRV groop than the control group （ P 〈 0.05 ）. PaCO2 and PH at T2 were not significantly different in both groups （P 〉 0.05 ）. Compared with control group, Ppeak（ 27.90 ± 1.44） at T2 was significantly lower in the IRV groop （P 〈 0.05） . Conclusion The ventilation was improved and gas exchange was promoted in over- weight patients undergoing gynecologic laparoseopic surgery with less side - effects compared with routine mode.