腹腔镜手术中不同通气模式对肺功能的影响

Effects of intraoperative ventilation strategies on respiratory function during laparoscopic surgery

目的 观察腹腔镜结直肠手术患者麻醉手术期间不同通气模式对患者呼吸功能的影响。方法 选择拟行腹腔镜结直肠癌根治术患者60例,均分为肺复张组（RM组）和常规通气策略组（C组）。在麻醉诱导前（T1）、麻醉诱导后插管前（T2）、气管插管后即刻（T3）、切皮前即气腹前（T4）、气腹30min（T5）、60min（T6）、90min（T7）、120min（T8）、缝合切口时（T9）及术毕（T10）时监测肺顺应性（Comp）、PaO2、PaCO2的变化。结果 与T4时比较,T5-T8时两组Comp均明显降低（P〈0.01）,而T9时RM组Comp明显降低,C组明显降低（P〈0.01）;与T4时比较,T8时RM组PaO2、PaCO2明显升高（P〈0.01）;C组PaO2明显降低,但PaCO2明显升高（P〈0.01）;且T8时RM组PaO2、PaCO2均明显高于C组（P〈0.01）。结论 腹腔镜结直肠手术中采用小潮气量合并肺复张的通气策略有利于增加肺顺应性和氧合作用。

Objective To evaluate the effects of intraoperative ventilation strategies on the respiratory function in patients undergoing laparoscopic colorectal surgery.Methods Sixty patients undergoing elective laparoscopic colorectal surgery were divided randomly into group RM（using lung recruitment maneuvers,RM）and groups C（using traditional ventilation strategy）.Compliance,arterial oxygen and carbon dioxide pressure were recorded at the time before induction（T1）,before（T2）and after（T3）intubation,before the pneumoperitoneum was established（T4）,30minutes（T5）,60minutes（T6）,90minutes（T7）and 120 minutes（T8）after pneumoperitoneum was established,after neuromuscular block agents infusion ended（T9）and right after the operation（T10）.Results During T5-T8,Comp in both groups was lower than Comp at T4（P〈0.01）.Comp in group RM was higher at T9 than T4（P〈0.01）.In contrast,Comp in group C was lower at T9 than T4（P〈0.01）.Group RM showed significant increase in PaO2 at T8than T4（P〈0.01）,but patients in group C were obvious decrease in PaO2,but was significantly higher in PaCO2 at T8than T4（P〈0.01）,and at T8PaO2 and PaCO2in group RM were higher than group C（P〈0.01）.Conclusion The ventilation strategy of lung RM with a low tidal volume applied to patients undergoing laparoscopic colorectal surgeries under general anesthesia was conducive to increase Comp,increase oxygenation,and might protect patients＇ respiratory function.