肥胖患者妇科腹腔镜手术中不同通气模式对呼吸功能的影响

Influenceon Different Modesof Mechanical Ventilation on Respiratory Function in Obesity Patientswith Gynecological Laparoscopic Operation

目的探讨妇科腹腔镜手术中三种不同通气模式对肥胖患者的呼吸功能的影响。方法选择60例行妇科腹腔镜手术全麻的肥胖患者,体重指数（BMI）30~35,年龄18~65岁,按随机数字表法分为压力控制通气组（pressure-controlled ventilation,PCV）、容量控制通气组（volume-controlled ventilation,VCV）和压力控制通气联合呼气末正压通气组（PCV＋PEEP）,分别为22、18、20例。气管插管后,予不同的通气模式,于麻醉前5 min（T0）、气腹前5 min（T1）、气腹后30 min（T2）、气腹解除后10 min（T3）、拔除气管导管后10 min（T4）,记录PH、氧合指数（OI）、二氧化碳分压（PaCO2）、氧分压（PaO2）、肺动态顺应性（Cdyn）。结果 VCV与PCV、PCV＋PEEP组相比,T2、T3时点PH值明显升高,PaCO2、PaO2、O I明显降低（P〈0.05）,Cdyn无明显差异（P〉0.05）;同组内T1与T2比较PH、Cdyn、OI、PaO2降低,PaCO2升高;OI、PaO2在T2、T3时点PCV＋PEEP组明显高于CVC和PVC组（P〈0.05）。结论压力控制通气联合呼气末正压通气在肥胖患者的妇科腹腔镜手术麻醉中改善通气功能,改善机体氧合,促进气体交换。

Objective To investigate the effect of respiratory function about three different ventilation modes in gynecological laparoscopic operation for obese patients. Methods Sixty obese patients undergoing general anesthesia, with body mass index（BMI）30- 35, aged 18- 65, undergoing gynecological laparoscopic operation were randomly divided into pressure control ventilation group（pressure- controlled ventilation, PCV）, volume control ventilation group（volume- controlled ventilation, VCV） and pressure controlled ventilation with positiveend expiratory pressuregroup（PCV＋PEEP）, respectively 22, 18, 20 patients each. After tracheal intubation three groups of patients using different ventilator modes, 5 min before anesthesia（T0）, 5 min after pneumoperitoneum（T1）, 30 min after pneumoperitoneum（T2）, 10 min after release pneumoperitoneum（T3）, 10 min after extubation（T4）, PH, oxygenation index（OI）, carbon dioxide（PaCO2）, partial pressureof oxygen（PaO2） and dynamic lungcompliance（Cdyn） were recored. Results VCV compared with PCV and PCV＋PEEP, p H was significantly increased, PaCO2, PaO2, OI decreased significantly（P〈0.05）, and Cdyn had no significant different（P〉0.05） at T2, T3; T1 compared with T2 PH, Cdyn, OI, PaO2 were decreased, PaCO2 were increased; OI, PaO2 in PCV＋PEEP group were significantly higher in CVC and PVC group at T2 and T3（P〈0.05）. Conclusion Obese patients, undergoing gynecologic laparoscopic operation by pressure controlled ventilation with positive end expiratory pressure group were improved ventilation function,improved oxygenation, promoted theexchangeof gases.