不同潮气量机械通气对腹腔镜手术患者术后肾功能的影响

目的探讨高潮气量通气和低潮气量通气对成年腹腔镜手术患者术后急性肾损伤发生风险的影响。方法采用前瞻性随机对照研究方法,将328例行腹腔镜手术的成年患者随机分为高潮气量组和低潮气量组,每组各164例。低潮气量组按照预测体重(PBW)6 mL/kg,高潮气量组按照PBW 10 mL/kg设置潮气量。观察两组腹腔镜手术后血清肌酐升高的发生率。结果低潮气量组和高潮气量组术后血清肌酐值升高发生率差异无统计学意义(P=0.629)。两组患者术后血清肌酐水平(P=0.534)及血清肌酐升高绝对值(P=0.137)差异均无统计学意义。结论与高潮气量相比,低潮气量机械通气不能降低腹腔镜手术患者发生术后急性肾损伤的风险。

Objective To investigate the effect of high tidal volume ventilation and low tidal volume ventilation on the risk of postoperative acute kidney injury in adult patients undergoing laparoscopic surgery.Methods A prospective randomized controlled trial was performed.328 adult patients undergoing laparoscopic surgery were randomly divided into the high tidal volume group and the low tidal volume group.Tidal volume was set according to predicted body weight(PBW)6 mL/kg in low tidal volume group and 10 mL/kg in high tidal volume group.The primary outcome was the incidence of elevated serum creatinine after laparoscopic surgery.Results There was no significant difference in the incidence of elevated serum creatinine between the low tidal volume group and the high tidal volume group(P=0.629).There was no significant difference in serum creatinine level(P=0.534)and absolute value of serum increase(P=0.137)between the two groups.Conclusion Compared with high tidal volume ventilation,low tidal volume ventilation does not significantly reduce the risk of postoperative acute kidney injury in patients undergoing laparoscopic surgery.