肺泡复张术和呼气末正压通气对肥胖病人全麻期间呼吸功能的影响

THE EFFECT OF ALVEOLAR RECRUITMENT MANEUVER AND POSITIVE END-EXPIRATORY PRESSURE ON RESPIRATORY FUNCTION IN OBESE PATIENTS UNDERGOING GENERAL ANESTHESIA

目的观察肺泡复张术和呼气末正压通气对肥胖病人全麻期间呼吸功能的影响。方法将40例择期行子宫肌瘤剔除术或者子宫切除术的肥胖病人随机分为肺复张组（RM组）和对照组（C组）,每组20例。RM组行肺泡复张术和呼气末正压通气,C组行容量控制通气。观察手术切皮时（T1）、切皮后30min（T2）、切皮后60min（T3）的心率（HR）、平均动脉压（MAP）、氧合指数（OI）、平台压力（Pplateau）、呼吸系统动态顺应性（Cdyn）以及拔管后10min（T4）的HR、MAP、OI。结果 RM组病人T1、T2、T3、T4时间点OI均显著高于C组（t=2.419-3.623,P〈0.05）,T1、T2、T3时间点Pplateau、Cdyn也显著高于C组（t=3.215-8.518,P〈0.05）。两组病人T1、T2、T3、T4时间点HR、MAP比较差异均无显著性（P〉0.05）。结论肺泡复张术和呼气末正压通气能改善肥胖病人全麻期间的呼吸功能,对血流动力学无明显影响。

Objective To investigate the effect of alveolar recruitment maneuver and positive end-expiratory pressure on respiratory function in obese patients undergoing general anesthesia. Methods Forty obese patients scheduled for myomectomy or hysterectomy were evenly randomized to alvelar recruitment maneuver（RM）group and control group,with 20 in each group.Alveolar RM and ventilation with positive end-expiratory pressure were carried out in RM group,and in the control group,volume control ventilation（VCV）was given.The heart rate when the skin was cut（T1）,30 min after skin cutting（T2）,60 min after skin cutting（T3）,mean arterial pressure（MAP）,oxygenation index（OI）,airway plateau pressure（Pplateau）and total respiratory dynamic compliance（Cdyn）were observed,and the HR,MAP and OI 10 min after extubation（T4）were observed as well. Results The OI in patients of RM group at T1,T2,T3 and T4time points was higher than that in patients of control group（t=2.419-3.623,P〈0.05）,and the Pplateau and Cdyn at T1,T2 and T3were higher as well（t=3.215-8.518,P〈0.05）.The differences in HR and MAP at T1,T2,T3 and T4between the two groups were not significant（P〉0.05）. Conclusion Alveolar recruitment maneuver and positive end-expiratory pressure can improve the alveolar oxygenation in obese patients under general anesthesia with no significant effect on hemodynamics.