乌司他丁联合压力控制通气对妇科腹腔镜手术呼吸动力学的影响

Effects of ulinastatin combined pressure controlled ventilation on pneumodynamics of laparoscopic surgery

目的评价乌司他丁联合压力控制通气对患者呼吸动力学的影响。方法择期行妇科腹腔镜全身麻醉手术患者40例,ASA分级Ⅰ级或Ⅱ级,年龄20~60岁,体重指数18~24 kg/m2,将患者随机分为两组：压力控制模式组（P组）,乌司他丁联合压力控制模式（PU组）,每组20例,PU组在手术开始前给予乌司他丁10 000u/kg。麻醉诱导维持用药相同,气管插管后行机械通气,于入室基础值（T0）、气腹即刻（T1）、体位改变后气腹5min（T2）、气腹后20 min（T3）、放气后5 min（T4）、手术结束后（T5）时记录顺应性（Cl）、阻力（Raw）、气道峰压（Pmax）、平台压（Pplat）和平均压（Pmean）等呼吸动力学参数。结果气腹后两组的Raw、Pmax、Pplat和Pmean均显著升高（P〈0.01）,气腹后各时刻PU组的Raw均低于P组（P〈0.05）。气腹后两组的Cl显著降低（P〈0.01）,PU组Cl在T4时刻降低（P〈0.05）,在T5时刻恢复（P〉0.05）,P组显著降低（P〈0.01）;与P组比较,气腹后PU组的Cl均显著高于P组（P〈0.01）。结论乌司他丁联合压力控制通气模式在气腹后改善肺顺应性以及术后肺顺应性的快速恢复方面有一定的影响。

【Objective】To investigate the effects of ulinastatin combined pressure controlled ventilation on pneumodynamics of laparoscopic surgery monitored by side stream spirpometry. 【Methods】 Forty patients（ASA classification Ⅰor Ⅱ）, aged 20~60 y, with a body index of 18~24 kg/m2, scheduled for laparoscopic surgery under general anesthesia, were randomly divided into 2 groups（n =20）： pressure controlled ventilation group（group P）, and ulinastatin combined pressure controlled ventilation group（group PU）. PU group was given ulinastatin before operation. Anesthesia was induced with midazolam, fentanil, propofol and vecuronium. The patients were tracheal intubated and mechanically ventilated. The respiratory mechanic parameters of compliance（CL）, resistance（Raw）, peak airway pressure（Pmax）, plateau pressure（Pplat）, mean pressure（Pmean）, positive end expiratory pressure（PEEP） were recorded at the time of supine position（T0）, the pneumoperitoneum instantly（T1）, 5 min of pneumoperitoneum after changing position（T2）, pneumoperitoneum after 20 min（T3）, deflating after 5 min（T4） and after the end of the surgery（T5）. 【Results】The Raw, Pmax, Pplat, Pmean were significantly higher in the two groups than CO2pneumoperitoneum（P〈0.01）. After CO2 pneumoperitoneum, the Raw of PU group was lower than group P（P〈0.05）. The Cl was significantly lower in the two groups than after CO2pneumoperitoneum（P〈0.01）. At T4, Cl was lower in group PU（P〈0.05）, but at T5 Cl was recovered（P〈0.05）. Compared with group P, the Cl was significantly higher in group PU（P〈0.01）.【Conclusion】Ulinastatin combined pressure controlled ventilation has certain effect in improving and recovering pulmonary compliance before and after operation.