不同呼吸参数在妇科腹腔镜手术全麻中的应用比较

Comparison of the Application of Different Respiratory Parameters in Gynecological Laparoscopic Surgery General Anesthesia

目的 探讨妇科腹腔镜手术中CO2气腹（气腹压15 mm Hg）状态下全麻控制呼吸中,维持良好通气呼吸参数的最佳组合.方法 选择2011年11月至2012年12月湖北省恩施自治州州中心医院收治的妇科腹腔镜手术患者60例,依据随机数字表法分成三组：Ⅰ组潮气量（VT）=8mL/kg,呼吸频率（f）=15次/min,呼吸比（I∶E）=1∶1.5;Ⅱ组VT=10 mL/kg,f=12次/min,I∶E=1∶2;Ⅲ组VT=12 mL/kg,f=10次/min,I∶E=1∶2.5.静吸复合全麻下调整呼吸机上不同的呼吸参数.记录三组患者围术期、呼吸末二氧化碳分压（PEr CO2）、呼吸道平台压（Pplat）、呼吸道峰值压（Ppeak）、肺顺应性等参数的变化值,并于气腹前、气腹后30 min、60 min,测定pH、动脉氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、静脉血二氧化碳分压（PvCO2）、肺泡气-动脉血氧分压差（PA-aO2）值,统计分析不同呼吸参数的组合对上述各项指标的影响.结果 三组患者围术期生命体征平稳,SpO2为99％ ～100％.气腹后,Ⅱ组PET CO2较Ⅰ、Ⅲ组升高显著（P＜0.05）,而Ⅲ组较Ⅰ组升高显著（P＜0.05）,Ⅰ组T6时恢复最快;三组Ppeak、Pplat进行性升高,T4后渐趋平稳（P＜0.05）;Ⅱ、Ⅲ组CL较Ⅰ组显著降低（P＜0.05）.对于PH、PaO2和PaCO2、PvCO2,Ⅰ组比Ⅱ、Ⅲ组有优势（P＜0.05）,Ⅱ组和Ⅲ组无明显统计学意义.结论 妇科腹腔镜全麻下呼吸参数的最佳组合为VT=8 mL/kg,f=15次/min,I∶E=l∶l.5.该组合通气/血流比匹配情况佳,能够使患者肺通气处于最佳状态,安全度过手术期.

Objective To explore the optimal ventilation respiratory parameters combination during general anesthesia controlled breath under CO2 pneumoperitoneum（pneumoperitoneum pressure 15 mm Hg）condition in gynecologic laparoscopic surgery.Methods During Nov.2011 and Dec.2012,60 gynecologic laparoscopic surgery cases were chosen and randomly divided into three groups（using a randmon number table method）,respiratory parameters of the ventilator for static suction composite under general anesthesia were adjusted.Group Ⅰ：VT =8 mL/kg,f =15 times/min,I∶ E =1∶ 1.5; group Ⅱ：VT=10 mL/kg,f=12 times/min,I∶ E =1∶ 2; group Ⅲ：VT =12 mL/kg,f =10 times/min,I∶ E =1 ∶ 2.5.The perioperative PET CO2,Pplat,Ppeak,CL parameters were recorded,and pH,PaO2,PaCO2,PvCO2,PA-a O2 value before the pneumoperitoneum and 30 min,60 min after pneumoperitoneum were tested,and the combinations of different respiratory parameters influence on the above each index were statistically analyzed.Results Perioperative vital signs of the three groups were stable,SpO2 99%-100%.After pneumoperitoneum,as for PET CO2,group Ⅱ was higher than group Ⅰ and Ⅲ （P 〈 0.05）,group Ⅲ was higher than group Ⅰ （P 〈 0.05）,but group Ⅰ showed the fastest recovery rate at timepoint T6 ; as for Ppeak and Pplat of the three groups showed progressive increase,and started to stabilize after T4（P 〈0.05） ; as for CL,group Ⅱ and Ⅲ were lower than group Ⅰ （P 〈 0.05）.As for PH,PaO2 and PaCO2,PvCO2,group Ⅰ showed superior effect than group Ⅱ and Ⅲ （P 〈 0.05）,group Ⅱ and Ⅲ had no statistically significant differences.Conclusion The best respiratory parameters combination under general anesthesia in gynecologic laparoscopy is VT =8 mL/kg,f =15 times/min,I∶ E =1∶ 1.5.This combination has the optimal ventilation/blood proportion,which ensures the best state of pulmonary ventilation to pass the perioperative period safely.