腹腔镜胆囊切除术中不同通气比对肺功能的影响

EFFECT OF DIFFERENT I:E ON LUNG FUNCTION DURING LAPAROSCOPIC CHOLECYSTECTOMY

目的 :探讨腹腔镜胆囊切除术 (LC)中不同吸呼比 (I:E)对肺功能的影响 ,确定最佳通气比。方法 :根据美国麻醉医师协会 (ASA)病人身体状况分级标准 ,选择ASAⅠ～Ⅱ级LC患者 4 5例 ,全麻诱导插管后随机分为3组 :Ⅰ组按Ⅰ :E =1:2通气 ,Ⅱ组按I :E =1:1.5通气 ,Ⅲ组按I:E =1:1通气 ,观察麻醉后气腹前 (T0 )及气腹后 5min(T5)、10min(T10 )、15min(T15)、30min(T3 0 )时血压 (BP)、心率 (HR)、氧饱和度 (SpO2 )、气道压 (Paw)、胸肺顺应性 (COM ) ,每组选 5例在T0 和T3 0 作动脉血气分析。结果 :Ⅰ～Ⅲ组气腹后BP、HR、Paw显著升高(P <0 .0 1) ,10min内达峰值 ,顺应性显著下降 (P <0 .0 1) ,气腹后 30min各项参数接近气腹前水平。Ⅱ、Ⅲ组在气腹后各点BP、Paw较Ⅰ组显著升高 (P <0 .0 5 ) ,顺应性显著下降 (P <0 .0 5 )。血气分析 :气腹后PaO2 显著下降 (P <0 .0 1) ,PaCO2 显著升高 (P <0 .0 1) ,PH值Ⅰ、Ⅲ组显著降低 (P <0 .0 5 )。结论 :LC术中选择I

Objective:To observe the effect of different I: E on lung function during LC, select the better I:E.Methods:Fourty five patients, for selective LC requiring general anaesthesia,ASA grade Ⅰ～Ⅱ,were randomly divided into three groups after intracheal intubation.I:E=1:2 for group one, I:E=1:1.5 for group two, I:E=1:1 for group three, to observe BP, HR, SpO 2,Paw, COM at the time after general anesthesia and before gastic abdomen(T 0),after gastic abdomen 5 minutes(T 5),10 minutes(T 10 ),15 minutes(T 15 ),30 minutes(T 30 ),five patients from every group were made Blood-gas-analysis at the times of T 0 and T 30 .Results:BP, HR, Paw increased and COM decreased significantly after gastic abdoemen in group Ⅰ～Ⅲ ( P <0.01),at the time of T 30 ,every obsertive parameters were same as the levels at the time of T 0. Bp,Paw were increased and COM decreased signficantly after gastic abdomen in group Ⅱ and group Ⅲ ( P <0.05).Blood-gas-analysis:PaO 2 decreased and PaCO 2 increased significantly after gastic abdomen in three groups( P <0.01 ),PH decreased significantly in group Ⅰ and group Ⅲ after gastic abdomen ( P <0.05).Conclusion:Effect of I:E= 1:2 on lung function is lesser during LC.