反比通气在肥胖患者妇科腔镜手术中对呼吸功能的影响

Effect of volume-controlled inverse ratio ventilation on pulmonary function in obese patients undergoing gynecological endoscopic surgery

目的探讨反比通气在肥胖患者行妇科腔镜手术中对呼吸功能的影响。方法选择2020年7至12月诸暨市第三人民医院择期行腹腔镜下妇科手术患者60例,按随机数字表法分为观察组与对照组,各30例,观察组气腹后通气模式为I︰E=1︰1,对照组为I︰E=1︰2。记录患者气管插管后10 min(T0)、气腹后15 min(T_(1))、气腹后60 min(T_(2))和气腹结束后15 min(T_(3))通气参数中的分钟通气量(MV)、呼吸频率(RR)、气道峰压(Ppeak)、平均气道压(Pmean)。同时在各时点抽取动脉血1 ml行血气分析,计算氧合指数(OI)、肺泡动态顺应性(Cdyn)、无效腔率(VD/VT);记录相应时点心率(HR)、平均动脉压(MAP)。观察患者术后有无缺氧、术后皮下气肿、肩痛、肺部并发症等发生情况。结果两组患者各时点SpO_(2)、P_(ET)CO_(2)、RR、HR、MAP、MV、VD/VT的差异均无统计学意义(均P>0.05)。对照组患者在T_(1)、T_(2)时点的Pmean、Ppeak均高于观察组,观察组T_(2)、T_(3)时点OI及T_(1)、T_(2)、T_(3)时点Cdyn均高于对照组(均P<0.05)。观察组术后肩痛发生率明显低于对照组(P<0.05)。结论反比通气可降低Ppeak,降低肺内分流,提高肥胖患者气腹下肺顺应性。

Objective To investigate the effects of volume-controlled inverse ratio ventilation on respiratory function in obese patients undergoing gynecological laparoscopic surgery.Methods Sixty ASA I-Ⅲpatients aged 18-65 ys undergoing elective laparoscopic gynecological surgery were randomly divided into two groups:30 patients in study group received I∶E=1∶1 ventilation mode and 30 patients in control group received I∶E=1∶2 ventilation mode.The RR,Ppeak,Pplat,Cdyn were recorded at 10 min(T0)after intubation,15 min(T_(1)),60 min(T_(2)),90 min(T_(3))post pneumoperitoneum,oxygen index(OI)and VD/VT were also recorded.Hypoxia,shoulder pain and pulmonary complications after operation were observed.Results OI at T_(2) and T_(3) in study group was significantly different compared with the control group(P<0.05).Pmean and Ppeak of control group at T_(1) and T_(2) were higher than those in study group(P<0.05).The Cdyn of the study group was significantly higher than that of the control group at all time points.Compared with the control group,the incidence of postoperative shoulder pain in the study group was significantly lower.Conclusion inverse ratio ventilation can reduce the peak airway pressure,reduce intrapulmonary shunt,and improve the pulmonary compliance in obese patients with pneumoperitoneum.