| 引用本文： |
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陈明慧,牛小引,王晖瀛,等.术中呼气末正压通气对行腹腔镜袖状胃切除术的肥胖患者肺功能的影响[J].同济大学学报（医学版）,2022,43(1):44-49. [点击复制]
- CHEN Minghui,NIU Xiaoyin,WANG Huiying,et al.Effect of positive end-expiratory pressure ventilation on pulmonary function in obese patients undergoing laparoscopic sleeve gastroectomy[J].同济大学学报（医学版）,2022,43(1):44-49. [点击复制]
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| 摘要: |
| 目的 探讨腹腔镜袖状胃切除术中使用呼气末正压（positive end expiratory pressure, PEEP)对患者术中及术后肺功能的影响。方法 选取2020年1月—2021年3月在同济大学附属第十人民医院行腹腔镜袖状胃切除术90例患者，随机分为3组，第1组使用单纯容量控制通气模式（volume control ventilation, VCV组，n=30），第2组使用容量控制通气模式联合5 cmH2O PEEP（P5组，n=30），第3组使用容量控制通气模式联合10 cmH2O PEEP（P10组，n=30）。术中潮气量设定为理想体质量×8 mL，呼吸频率12次/min，吸氧浓度60%，呼气暂停时间（pause time, Tpause）设为10%，建立气腹后呼吸频率调整为14次/min。于入手术室后（T0）、气管插管后5 min（T1）、气腹建立后30 min（T2）、停气腹后5 min（T3）、拔管送恢复室后30 min（T4），记录心率、血压并采取桡动脉血进行血气分析。计算氧合指数、死腔率。记录T1、T2、T3的气道平台压、峰压、肺顺应性。记录患者术后有无发生肺部并发症、术后住院天数（术后第1天至出院日）及30 d生存率。结果 与VCV组相比，P5组、P10组T2氧合指数高(P<0.05)。P5组T1、T3死腔率小于VCV组(P<0.05)，P10组各时间点死腔率显著低于VCV组(P<0.05)。相同时间点组间肺泡-动脉氧分压差差异无统计学意义(P>0.05)。气腹建立后各组肺顺应性均降低，但是P10各时间点与VCV组和P5组相比，均差异有统计学意义(P<0.05)。气腹建立后平台压及峰压均升高(P<0.05)。P10组T1、T3平台压与VCV组相比，均差异有统计学意义(P<0.05)。P10组T1峰压较VCV组高(P<0.05)。3组心率、血压、术后肺部并发症发生率、住院天数及30 d生存率均差异无统计学意义(P>0.05)。结论 在肥胖患者行腹腔镜袖状胃切除术中，采用容量控制模式通气时使用10 cmH2O PEEP可以显著改善肺顺应性，使用5 cmH2O或10 cmH2O PEEP均可改善氧合，但是作用持续时间短。 |
| 关键词: 呼气末正压 容量控制通气 腹腔镜袖状胃切除 肥胖 肺功能 |
| DOI：10.12289/j.issn.1008-0392.21117 |
| 投稿时间：2021-03-29 |
| 基金项目: |
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| Effect of positive end-expiratory pressure ventilation on pulmonary function in obese patients undergoing laparoscopic sleeve gastroectomy |
| CHEN Minghui,NIU Xiaoyin,WANG Huiying,YU Hongli,SUN Shiyu,ZHAO Xuan |
| (Department of Anesthesiology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200072, China;Department of Anesthesiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200070, China) |
| Abstract: |
| Objective To evaluate the effect of positive end-expiratory pressure ventilation(PEEP) on pulmonary function in obese patients undergoing laparoscopic sleeve gastroectomy. Methods Ninety obese patients scheduled for the laparoscopic sleeve gastroectomy in Shanghai Tenth Peoples Hospital from January 2020 to March 2021 were randomized into three groups(n=30 each): volume control ventilation group(VCV group), volume control ventilation combined with 5 cmH2O PEEP group(P5 group) and volume control ventilation combined with 10 cmH2O PEEP group(P10 group). After tracheal intubation intermittent positive pressure ventilation(VT 8 mL/kg×ideal weight, respiration rate 12 breaths/min, I∶E 1∶2, fraction of inspired oxygen 60% and Tpause 10%) was performed. After the onset of pneumoperitoneum the respiration rate was changed to 14 breaths/min. After entering the operation room(T0), at 5 min after tracheal intubation(T1), at 30 min after pneumoperitoneum(T2), at 5 min after stopping of pneumoperitoneum(T3), at 30 min after entering the PACU(T4), arterial blood samples were collected for blood gas analysis, and the oxygenation index(OI), dead space fraction(VD/VT) were calculated; the heart rate and blood pressure were recorded at above time points. Peak airway pressure, plateau pressure and lung compliance(Cydn) of T1, T2 and T3 were recorded. The incidence of postoperative pulmonary complications(PPCs), the length of hospital stay(after the operation) and 30 day survival rate were documented. Results Compared with VCV group OI was higher at T2 in group P5 and group P10(P<0.05). Dead space fraction in group P5 at T1 and T3 was lower than that in group VCV(P<0.05). Dead space fraction in group P10 was lower than that in group VCV at all time points(P<0.05). No significant change was found in alveolar-arterial oxygen gradient among the three groups(P>0.05). After pneumoperitoneum was established, Cydn of each group was decreased(P<0.05); however, Cydn of P10 group was higher than group VCV and group P5 at all time points(P<0.05). After the establishment of pneumoperitoneum, both plateau pressure and peak pressure increased in each group(P<0.05). Heart rate, blood pressure, the incidence of PPCs, the length of hospital stay and 30 day survival rate were not statistically different among three groups(P>0.05). Conclusion In patients undergoing the laparoscopic sleeve gastroectomy, 10 cmH2O PEEP can improve the lung compliance. Both 5 cmH2O PEEP and 10 cmH2O PEEP can improve the oxygenation during the operation, but the effects are transient. |
| Key words: positive end-expiratory pressure volume control ventilation laparoscopic sleeve gastroectomy obese pulmonary function |
