侧卧折刀位腹膜后腹腔镜手术不同气腹压力对肺内分流及肺顺应性的影响

Influence of different pneumoperitoneum pressures on pulmonary shunt and pulmonary compliance in patients undergoing retroperitoneal laparoscopic surgery

目的观察侧卧折刀位腹膜后腹腔镜手术不同气腹压力对肺内分流及肺顺应性的影响.方法将2012-11/2015-11临海市第二人民医院接受治疗的102例择期全身麻醉下行腹膜后腔镜手术患者纳入本研究.按照随机数字表法将患者分为A组和B组,A组:气腹压力10 mm Hg;B组:气腹压力15 mm Hg.观察患者麻醉后机械通气PETCO_2(呼气末二氧化碳分压)稳定时(T_0);气腹建立后15 min(T_1);气腹建立后35 min(T_2);停药后10 min(T_3)4个时间点药物和液体用量、不同时间点血压、心率、肺内分流及动态肺顺应性(Cdyn)变化情况.结果两组患者从入手术室到T_2期间药物和液体用量对比,无统计学差异(P>0.05);A组T_2时收缩压低于B组同时期(128.02 mm Hg±7.98 mm Hg vs 149.94 mm Hg±8.31 mm Hg),有统计学差异(P<0.05);A组T_2时Cdyn高于B组(65.22 mL/cm H_2O±5.37 mL/cm H_2O vs 53.98 mL/cm H_2O±5.33 mL/cm H_2O)同时期和同组T_1、T_3时期,PaCO_2低于B组同时期(4.54 kPa±0.51 kPa vs 5.89 kPa±0.55 kPa)和同组T_1、T_3时期,有统计学差异(P<0.05).A组睁眼时间、自主呼吸恢复时间、拔管时间、定向力恢复时间均低于对照组,有统计学差异(P<0.05);A组不良反应发生率低于B组,有统计学差异(P<0.05).结论侧卧位折刀位腹膜后腹腔镜手术患者气腹压力10mm Hg较15 mm Hg患者能明显改善其肺的顺应性及术后恢复情况,且安全性较高.

AIM To explore the influence of different pneumoperitoneum pressures on the pulmonary shunt and pulmonary compliance in patients undergoing laparoscopic surgical procedures in a lateral position. METHODS One hundred and two patients who underwent retroperitoneal laparoscopic surgery at the Second People＇s Hospital of Linghai were randomly divided into either group A or group B. Group A underwent the surgery at a pneumoperitoneum pressure of 10 mmHg, and group B underwent the surgery at a pneumoperitoneum pressure of 15 mmHg. The amount of drugs and liquids used, blood pressure, heart rate, pulmonary shunt, and lung compliance were observed. RESULTS There was no significant difference in the amount of drugs and liquids used between the two groups （P 〉 0.05）. Systolic blood pressure at T2 （35 min after pneumoperitoneum was established） was significantly higher in group A than in group B （128.02 mmHg ＋ 7.98 mmHg vs 149.94 mrnHg ＋ 8.31 mmHg, P 〈 0.05）. Dynamic pulmonary compliance at T2 stage was significantly higher in group A than in group B （65.22 mL/cm H20 ＋ 5.37 mL/cm H20 vs 53.98 mL/cm H20 ＋ 5.33 mL/cm H20）, and dynamic pulmonary compliance at T2 stage was significantly higher than that at T1 （15 min after pneumoperitoneum was established） and T3 （10 min after drug withdrawl） stages in group A （P 〈 0.05）. PaCO2 at T2 stage was significantly lower in group A than in group B （4.54 kPa ＋ 0.51 kPa vs 5.89 kPa ＋ 0.55 kPa）,and PaCO2 at T2 stage was significantly higher than that at T1 and T3 stages in group A （P 〈 0.05）. Time to eye opening, time to recovery of spontaneous breathing, time to extubation, and time to orientation recovery were significantly shorter in group A than in group B （P 〈 0.05）. The rate of adverse reactions was significantly lower in group A than in group B （P 〈 0.05）. CONCLUSION A pneumoperitoneum pressure of 10 mmHg in retroperitoneal laparoscopic surgery can significantly improve pulmonary compliance and postoperative recovery and has higher safety than a pneumoperitoneu_m pressure of 15 mmHg.