压力容量环指导呼吸末正压通气对腹腔镜胃癌根治术患者脑保护的影响

Effect of positive end-expiratory pressure ventilation guided by pressure-volume curve on brain protection in patients undergoing laparoscopic radical gastrostomy

目的探讨压力容量环(P-V环)指导呼吸末正压通气(PEEP)对腹腔镜胃癌根治术患者脑保护的影响。方法选取2012年2月-2014年2月择期全身麻醉下二氧化碳(CO2)气腹行腹腔镜下胃癌根治术的患者80例,ASAⅠ、Ⅱ级,随机分为研究组P组(P-V环组)和对照组C组,对照组(C组)和研究组(P组),每组40例。记录两组在气腹前(T0)、气腹后30 min(T1)和60 min(T2)的心率及血压的变化,分别抽取各时点的颈静脉球血和桡动脉血进行血气分析,检测脉血氧分压(Pa O2)、动脉二氧化碳分压(Pa CO2)、动脉血氧饱和度(SPO2)、颈内静脉血氧分压(Pjv O2)、颈内静脉血氧饱和度(Sjv O2)、并计算颈内静脉血氧含量(Cjv O2),动脉-颈内静脉血氧含量差(Ca-jv DO2)。结果两组在气腹后T1、T2时点动脉二氧化碳分压(Pa CO2)、颈内静脉血氧分压(Pjv O2)、颈内静脉血氧含量(Cjv O2)、颈内静脉血氧饱和度(Sjv O2)明显升高(P<0.05),而两组动脉-颈内静脉血氧含量差(Ca-jv DO2)在各时点均显著减小(P<0.05);与C组相比P组Pjv O2、Sjv O2、Cjv O2均高于C组,而且Da-jv O2P组明显小于C组,差异有显著性(P<0.05)。结论在P-V环指导PEEP通气可改善CO2气腹胃癌根治术患者的脑血流量和改善脑氧供需平衡。

【Objective】To investigate the effect of positive end expiratory pressure（positive end-expiratory,pressure, PEEP） guided by pressure volume loop（pressure-volume curve, P-V ring） on the brain protection in the patients with laparoscopic gastric cancer. 【Methods】80 patients（ASA I ～II, from 2012 February to 2014 year February） scheduled to undergo laparoscopic radical gastrostomy under CO2 pneumoperitoneum, were randomly divided into study group（P group, n =40） and the control group C,（C group, n =40）. The heart rate and blood pressure of the two groups were recorded before pneumoperitoneum（T0）, 30 min after pneumoperitoneum（T1）, 60 min（T2） after pneumoperitoneum. Blood samples of jugular bulb and radial artery were obtained at each time point for blood gas analysis. The arterial oxygen pressure（Pa O2）, arterial carbon dioxide pressure（Pa CO2）, arterial oxygen saturation（Sp O2）, internal jugular venous blood oxygen partial pressure（Pjv O2）, internal jugular venous oxygen saturation（Sjv O2）, jugular venous oxygen content（Cjv O2）, and arterial-jugular venous oxygen content difference（Ca-jv DO2） were detected. 【Results】For the two groups, the Pa CO2, Pjv O2, Cjv O2 and Sjv O2 were increased significantly at T1 and T2after pneumoperitoneum compared with T0（ P〈0.05）, while the Ca-jv DO2 in two group were decreased significantly at each time point（ P〈0.05）. Compared with C group, Pjv O2, Sjv O2,Cjv O2 of P group were higher than C group, and Da-jv O2 of P group was significantly less than the C group（ P〈0.05）.【Conclusion】Positive end-expiratory pressureguided by pressure-volume curve can improve cerebral oxygen supply and improve cerebral oxygen supply and demand balance in patients undergoing laparoscopic radical gastrostomy under the CO2 pneumoperitoneum.