肺保护性通气策略对腹腔镜下食管裂孔疝合并GERD患者肺功能的影响研究

Effect of protective pulmonary ventilation on laparoscopic lung function in patients with esophageal hiatal hernia and gastroesophageal reflux disease

目的探讨采用肺保护性通气策略对腹腔镜下治疗食管裂孔疝合并胃食管反流患者(GERD)呼吸功能的影响。方法前瞻性选取2014年4月至2017年10月,新疆维吾尔自治区人民医院行择期腹腔镜下食管裂孔疝修补术与胃底折叠术的80例患者作为研究对象,按照入院先后顺序分为对照组和观察组。对照组采用传统容量控制通气模式,按患者体重将潮气量设置为10 ml/kg,呼吸频率设置为12次/min;观察组采用肺保护性通气策略,按患者体重将潮气量设置为6 ml/kg,呼吸频率设置为16次/min,并给予5 cm H2O呼气末正压通气。分别在气腹前(T0)、气腹后2 h(T1)、气腹后4 h(T2)记录2组患者1次平均动脉压(MAP)、中心静脉压(CVP)。在T0、T1、T2、手术后24 h(T3)记录2组患者的肺顺应性(C)、心率(HR)、呼吸频率(RR),并抽取血气,计算氧合指数(OI)。结果在观察组和对照组中均发现,T1和T2组比T0组的MAP、CVP和C高,差异具有统计学意义(均P <0. 05);相对T0组,T1和T2组的HR、RR和OI指标均处于较高水平(均P <0. 05)。另外,在同一时间段内,观察组在T0、T1、T2和T3时间HR、RR和OI指标均高于对照组,差异具有统计学意义(均P <0. 05),但MAP和CVP并未差异(均P> 0. 05)。结论与传统容量控制通气模式相比,采用肺保护性通气策略可以改善腹腔镜下治疗食管裂孔疝合并GERD患者的呼吸功能。

Objective To investigate the effect of laparoscopic ventilation on respiratory function in patients with esophageal hiatal hernia and GERD under laparoscopy. Methods A prospective study was conducted in Department of Anesthesiology,Xinjiang Uygur Autonomous region including 80 cases of patients who had undergone laparoscopic esophageal hiatal hernia repair from April 2014 to October 2017 were selected and divided into control group and observation group.In the control group,the traditional capacity control ventilation mode was adopted and the tidal volume was set at 10 ml/kg according to the patient with weight.Breathing rate is set to 12 times per minute.In the observation group,the lung ventilation strategy was adopted.The tidal volume was set to 6 ml/kg according to the patient with weight and 5 cm H 2O positive end-pressure ventilation.The mean arterial pressure（MAP）and central venous pressure（CVP）of the two groups were recorded before pneumoperitoneum（T 0）,2 h after pneumoperitoneum（T 1）and 4 h after pneumoperitoneum（T 2）respectively.Lung compliance（C）,heart rate（HR）and respiratory rate（RR）were recorded at T 0,T 1,T 2 and 24 hours after surgery（T 3）.Blood gas was drawn and oxygenation index（OI）was calculated. Results Higher levels of MAP,CVP and C were found among T 1 and T 2 than T 0,both in the control and observation group（all P 〈0.05）,so the same as HR,RR and OI.In addition,higher level of C was found in the observation group than the control group at T 0,T 1 and T 2,respectively（all P 〈0.05）,but not for MAP and CVP. Conclusion Compared with the traditional volume control ventilation mode,pulmonary protective ventilation strategy can improve respiratory function of patients with laparoscopic treatment of esophageal hiatal hernia and GERD.