低水平呼气末正压通气对胃癌微创手术患者脑血流的影响

Effects of low level positive end-expiratory pressure ventilation on cerebral blood flow in patients with gastric cancer

目的研究低水平呼气末正压通气对胃癌微创手术患者脑血流的影响。方法选择胃癌微创手术患者100例,采用随机数字表法分为观察组和对照组各50例,其中观察组的通气参数是潮气量8 ml/kg,呼吸频率每分钟12次、呼气末正压5 cm H2O。对照组潮气量及呼吸频率同观察组。分别在气腹前和气腹1 h后记录两组患者的血流动力学指标。结果两组患者气腹前和气腹后1 h的平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)含量比较,差异均无统计学意义(P﹥0.05)。气腹前两组患者的Vm、Sjv O2、Da-jv O2、Pa CO2含量相比,差异无统计学意义(P﹥0.05);气腹1 h后,观察组Vm、Pa CO2低于对照组,且Sjv O2、Da-jv O2高于对照组,差异有统计学意义(P﹤0.05)。结论低水平呼气末正压通气,有利于胃癌微创手术患者脑血流动力学的稳定,维持患者的脑供血平衡,是一种值得在临床上推广的治疗方式。

Objective To study the effect of low level positive end-expiratory pressure （PEEP） ventilation on the cerebral blood flow in patients with gastric cancer. Method 100 patients with gastric cancer who had underwent minimally invasive surgery were included in this study, and were randomized into either study group or control group according to a random number table, with 50 cases in each. The study group had the ventilation parameters as tidal volume = 8 ml/kg, respiratory frequency=12/min, and end-expiratory positive pressure = 5 cmH2O. The control group had same levels of tidal volume and respiratory rate with the study group. The hemodynamic indexes of both groups before and 1 h after the development of pneumoperitoneum were recorded, respectively. Result The mean arterial pressure （MAP）, heart rate （HR） and central venous pressure （CVP） of both groups before and 1 h after the development of pneumoperitoneum were similar （P〉0.05）. Before the development of pneumoperitoneum, the Vm, SjvO2, Da-jvO2 and PaCO2 levels were comparable in both groups （P〉0.05）; While after 1 h of pneumoperitoneum, the Vm and PaCO2 were lower, and the SjvO2 and DajvO2 were higher in the study group compared with that of the control group, with significant difference observed （P〈 0.05）. Conclusion Low level positive end-expiratory pressure ventilation is beneficial in stabilizing the cerebral blood flow dynamics in patients with gastric cancer, and may maintain the balance of cerebral blood supply, which is clinically applicable.