肺保护性通气策略对妇科腔镜手术患者肺功能的影响

Effect of Protective Lung Ventilation on Pulmonary Function of Patients with Gynecological Laparoscopic Surgery

目的探讨肺保护性通气策略对行腔镜手术治疗妇科患者肺功能的影响。方法选择我院收治的腔镜手术的妇科患者64例为研究对象,随机分为常规通气组32例(A组:全程通气模式为V_T:10mL/kg,RR:10次/mim,吸呼比:1:2),保护性通气组32例(B组:全程通气模式为V_T:6mL/kg,RR:16~20次/mim,吸呼比:1:2,PEEP:5cmH_2O,术中间隔15min进行规律肺泡复张一次)。比较插管前(T_0)、气腹后(T_1)、手术60min(T_2)、气腹毕(T_3)、术毕(T_4)时间点两组患者气道峰压(Ppeak)、平均气道压(Pmean)及肺顺应性(CL)差异,同时在以上时间点比较PaO_2、PaCO_2、肺内分流率(Q_s/Q_t)、P_(ET)CO_2差异;比较术前、苏醒后患者肺功能指标差异。结果 T_0时两组间Ppeak、Pmean、CL无差异,B组T_1~T_4时Ppeak显著低于A组,T_1~T_4时CL显著高于A组,在T_1~T_3时Pmean显著低于A组,差异均有统计学意义(P<0.05);T_0时两组患者肺氧合功能指标无差异,T_0~T_4时两组患者PaO_2均无明显改变,T_1~T_3时B组PaCO_2、P_(ET)CO_2要显著高于A组,T_1~T_3时B组Qs/Qt要显著低于A组,差异均有统计学意义(P<0.05);术前FVC、FEV1、PEF、FEV1/FVC均无明显差异,苏醒后FEV1/FVC无显著变化,B组FVC、FEV1、PEF要显著高于A组,差异均有统计学意义(P<0.05)。结论对行腔镜手术治疗的妇科患者采用肺保护性通气策略可以明显改善肺顺应性和氧合能力,提高患者术后肺功能。

Objective To investigate the effects of lung protective ventilation strategies on laparoscopic surgery for gyne-cological patients with pulmonary function. Methods 64 cases of patients with gynecological laparoscopic surgery in our hospital were randomly divided into routine ventilation group with 32 cases（Group A：the whole ventilation mode for VT：10mL/kg,RR：10/ min,breath ratio：1：2）and 32 cases of protective ventilation group（Group B：the whole ventilation mode for VT：6mL/kg,RR：16~20 / min,breath ratio：1：2,PEEP：5cmH2O,regular pulmonary alveolar recruitment for every 15min）. The differences of peak airway pressure（ Ppeak） ,mean airway pressure（ Pmean） and lung compliance（ CL） in two groups were compared at the point of time of before intubation（T0）,during pneumoperitoneum（T1）,60min in operation（T2）,post-pneumoperitoneum（T3）,after surgery （T4）. At the same time,the difference of PaO2,PaCO2,intrapulmonary shunt rate（Qs/Qt）,PETCO2 were compared at the same time points,and the difference of pulmonary function indexes before and after recovery was compared. Results There was no difference in Ppeak,Pmean,CL between the two groups at T0. In gruop B,Ppeak at T1 ~T4 was significantly lower than that in group A（P〈0. 05）,CL at T1-T4 was significantly higher than that in group A（P〈0. 05）,Pmean was significantly lower than in A group（P〈0. 05）at T1~T3. There was no difference between the groups in the oxygenation index of the patients in the two groups at T0. The two groups of patients with Pa02 did not significantly change（P〉0. 05）at T0-T4,PaCO2 and PETCO2 in group B was significantly higher than that in group A（P〈0. 05）at T1-T3,but Qs/Qt was significantly lower than that in group A（P〈0. 05）. There was no significant difference in FVC,FEV 1 ,PEF and FEV 1/FVC before operation,and there was no significant change in FEV1/FVC after awakening,FVC,FEV1 and PEF in group B were significantly higher than those in group A（P〈0. 05）. Conclu-sion The treatment of laparoscopic surgery in gynecological patients with lung protective ventilation strategies can significantly im-prove lung compliance and oxygenation capacity,improving pulmonary function of patients after operation.