小潮气量加低水平呼气末正压通气对腹腔镜胆总管手术患者脑保护的影响

Effects of low tidal volume combined with low level of positive end expiratory pressure on cerebral protection in patients with laparoscopic choledocholith operation

目的探讨小潮气量（VT）加低水平呼吸末正压通气（PEEP）对腹腔镜胆总管手术患者脑保护的影响。方法选取2012年5月-2014年5月择期全麻下行腹腔镜胆总管手术的患者60例,ASAⅠ-Ⅱ级,随机分为研究组（VT＋PEEP研究组）和对照组,每组30例。记录两组在气腹前（T0）、气腹后30 min（T1）、60 min（T2）的心率及血压的变化,并分别抽取各时点的颈静脉球血和桡动脉血进行血气分析,检测动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、动脉血氧饱和度（SPO2）、颈内静脉血氧分压（PjvO2）、颈内静脉血氧饱和度（SjvO2）,并计算颈内静脉血氧含量（CjvO2）,动脉-颈内静脉血氧含量差（Da-jvO2）。结果两组在气腹后T1和T2时点动脉二氧化碳分压（PaCO2）、颈内静脉血氧分压（PjvO2）、颈内静脉血氧含量（CjvO2）和颈内静脉血氧饱和度（SjvO2）明显升高（P〈0.05）,而两组动脉-颈内静脉血氧含量差（Da-jvO2）在各时点均明显减小（P〈0.05）;与对照组相比研究组PjvO2、SjvO2和CjvO2均高于对照组,而且Da-jvO2研究组明显小于对照组,差异有统计学意义（P〈0.05）。结论在VT＋PEEP通气可改善二氧化碳CO2气腹腹腔镜胆总管手术患者的脑血流量和改善脑氧供需平衡。

【Objective】To investigate the effect of low tidal volume combined with low level of positive end expiratory pressure on cerebral protection in patients with laparoscopic choledocholith operation.【Methods】Sixty patients（ASA I-II, from May 2012 to May 2014） scheduled to undergo laparoscopic common bile duct operation under CO2 pneumoperitoneum were randomly divided into the study group（n = 30） and the control group（n = 30）. The heart rate and blood pressure of the two groups before pneumoperitoneum（T0）, 30 min after pneumoperitoneum（T1）,60 min after pneumoperitoneum（T2） were recorded. Blood samples of jugular bulb and radial artery were obtained at each time point for blood gas analysis, the arterial oxygen pressure（PaO2）, arterial carbon dioxide pressure（PaCO2）,arterial oxygen saturation（SPO2）, internal jugular venous blood oxygen partial pressure（PjvO2） and internal jugular venous oxygen saturation（SjvO2） were detected, and jugular venous oxygen content（CjvO2） and arterial-jugular venous oxygen content difference（Da-jvO2） were calculated. 【Results】PaCO2, PjvO2, CjvO2 and SjvO2 in the two groups were increased significantly at T1 and T2after pneumoperitoneum compared with those at T0（P〈0.05）, while the Da-jvO2 in two groups were decreased significantly at each time point（P〈0.05）. PjvO2, SjvO2, CjvO2 of study group were higher than those of control group, and Da-jvO2 of study group was significantly less than that of control group（P〈0.05）.【Conclusions】Low tidal volume combined with low level of positive end expiratory pressure can improve cerebral oxygen supply and demand balance in patients undergoing laparoscopic common bile duct operation under CO2 pneumoperitoneum.