腹腔镜食管裂孔疝修补术中调整麻醉机呼吸参数对患者呼吸动力学的动态观察研究

Dynamic observation of respiratory dynamics for the laparoscopic hiatal hernia repair patients when adjust respiratory parameters of anesthesia machine

目的探讨腹腔镜食管裂孔疝修补术中适当调整麻醉机呼吸参数对患者气腹不同时间的动脉血二氧化碳分压(PaCO_2)、呼气末二氧化碳分压(PetCO_2)及吸气平台压(Plat)、气道峰压(Peak)等呼吸动力学的影响。方法 40例择期行全身麻醉腹腔镜食管裂孔疝修补术的患者随机数字表法分为两组,每组各20例,A组:设置麻醉机呼吸参数始终不变:潮气量8 ml/kg,通气频率12次/min,PEEP 0 mm Hg,吸呼比1∶2,吸入氧浓度:100%,氧流量:2 L/min;B组:于气腹10 min后仅调整潮气量为6 ml/kg,通气频率15次/min,PEEP 5 mm Hg,其余呼吸参数不变。分别于气管插管后5 min(T0)、气腹后10 min(T1)、气腹后30 min(T2)及放气后10 min(T3)四个时间点记录并比较两组患者的心率(HR)、血压(BP)、动脉血氧分压(PaO_2)、PaCO_2、Pet CO2及Plat、Peak。结果两组患者气腹前后PaO_2均无统计学差异(P>0.05);两组患者气腹后T1时HR、BP、PaCO_2、PetCO_2、Plat、Peak均较T0升高,差异有统计学意义(P<0.01或P<0.05);适当调整呼吸参数后,A组患者T2时HR、BP、PaCO_2、PetCO_2、Plat、Peak与T1比较差异均无统计学意义(P>0.05),B组患者T2时HR、BP、PaCO_2与T1比较差异均无统计学意义(P>0.05),但PetCO_2、Plat、Peak均较T1明显降低,差异有统计学意义(P<0.01);T3时两组患者HR、BP、PaCO_2、PetCO_2、Plat、Peak均恢复至T0水平,差异均无统计学意义(P>0.05)。结论腹腔镜食管裂孔疝修补术,于气腹后10 min调整患者呼吸参数为:潮气量6 ml/kg,通气频率15次/min,PEEP 5 mm Hg,可降低患者PetCO_2、Plat及Peak,但PaCO_2、PaO_2及血流动力学波动不明显;腹腔镜食管裂孔疝修补术中,不能以监测PetCO_2来精确预测患者PaCO_2的变化。

Objective To observe the effects of PaCO2、PetCO2 and Plat、Peak when appropriate adjust the respiratory parameters of anesthesia machine for the laparoscopic hiatal hernia repair patients. Methods 40 cases of elective suggury of laparoscopic hiatal hernia repair were randomly divided into two groups,20 cases in each group, Group A： set respiratory parameters of anesthesia machine remains unchanged：Tidal volume 8ml/kg,respiratory rate：12 each/min,PEEP：0 mmHg,Inspiratory to expiratory ratio：1∶2,FiO2：100%,Oxygen flow：2 L/min;Group B：adjust the respiratory parameters 10 minnutes after insufflation,Tidal volume 6ml/kg,respiratory rate：15 each/min,PEEP：5 mmHg,other respiratory parameters remains unchanged.HR、BP、PaO2、PaCO2、PetCO2、Plat and Peak were record and compared at four points：5 minnutes after intubation（T0）、10 minnutes after insufflation（T1）、30 minnutes after insufflation（T2）and 10 minnutes after exsufflation（T3）.Results There were no significant difference in PaO2 between two groups （P 〉0.05）;HR、BP、PaCO2、PetCO2、Plat and Peak of T1 moment in group A and group B were significantly＆nbsp;increase than T0 moment（P 〈0.01 or P 〈0.05）;After the respiratory parameters were appropriate adjusted, there were no significant difference of group A in HR、BP、PaCO2、PetCO2、Plat and Peak between T2 and T1 （P 〉0.05）;while there were no significant difference of group B were found in HR、BP and PaCO2 between T2 and T1（P 〉0.05）,but PetCO2、Plat and Peak of T2 moment were significantiy decrease then T1 moment （P 〈0.01）.There were no significant difference in HR、BP、PaCO2、PetCO2、Plat and Peak between T3 and T0（P 〉0.05）.Conclusion Adjust the respiratory parameters 10 minnutes after insufflation：tidal volume 6ml/kg,respiratory rate：15 each/min,PEEP：5mmHg,PetCO2、Plat and Peak were significantiy decreased in Laparoscopes hiatal hernia repair;but monitor PetCO2 could not accurately respons the PaCO2 .