肥胖患者腹腔镜手术中不同通气模式对围术期肺功能的影响

摘要

目的 研究行腹腔镜下直肠癌根治术的肥胖患者不同通气模式对围术期肺功能的影响.方法 选择2014年6月到2015年12月在安徽医科大学附属省立医院接受腹腔镜直肠癌根治术的肥胖患者60例,随机分为对照组(C组)、呼吸末正压通气联合保护性肺通气组(P组)和肺复张组(R组),每组20例.于气腹前5分钟(T0),气腹10分钟(T1)、30分钟(T2)、60分钟(T3)、90分钟(T4),气腹结束后5分钟(T5)和拔管前5分钟(T6),出PACU即刻(T7),进行动脉血气分析,监测动脉氧分压(PaO2)并计算氧合指数(PaO2/FiO2),记录气道峰压(Ppeak)、及肺动态顺应性(Cdyn).记录各组患者到达气管拔管指征的时间和送出麻醉复苏室(PACU)标准的时间.术后随访记录患者术后肺部并发症和住院时间.结果 P组T3、T4、T5、T7时的PaO2,T2、T3、T4、T7时的PaO2/FiO2,及T2时的Cydn较C组升高,差异有统计学意义(P＜0.05);R组T3、T5、T6时的PaO2,T2、T3、T4、T6、T7时的PaO2/FiO2,及T2、T3、T4、T5时的Cydn较C组均升高,T2、T3、T4、T5的Ppeak降低,差异有统计学意义(P＜0.05);P组及R组达到拔管标准的时间、送出PACU时间及术后住院时间显著低于C组,差异有统计学意义(P＜0.05);R组在T2、T3及T4时的Ppeak较P组降低,Cdyn升高,差异有统计学意义(P＜0.05).3组患者术后肺部并发症差异无统计学意义(P＞0.05).结论 肺复张及呼气末正压通气联合保护性肺通气两种通气模式均能改善肥胖患者行腹腔镜下直肠癌根治术围术期肺功能,促进术后肺功能恢复.%Objective To evaluate the effect of intraoperative ventilation strategies on respiratory function in obese patients undergoing laparoscopic colorectal cancer radical prostatectomy during perioperative period.Methods Sixty obese patients were enrolled in this study from 2014 Jun.to 2015 Dec.in the hospita,and were randomly divided into three groups:control group (group C),positive end expiratory pressure (PEEP) after the protective ventilation group (group P) and alveolar recruitment maneuver group (group R).At 5 rmin before creation of pneumoperitoneum(T0),at 10 min(T1),30 min(T2),60 min(T3) and 90 min(T4) of pneumoperitoneum,immediately after the end of pneumoperitoneum(T5),5 min after intubation(T6) and immediately before discharge from PACU(T7),arterial blood samples were collected for blood gas analysis to monitor the arterial partial pressure of oxygen (PaO2) and to calculate the oxygenation index (PaO2/FiO2).Peak airway pressure (Ppeak) and dynamic lung compliance (Cdyn) were recorded.Patients were followed up until discharge and postoperative pulmonary complications were recorded.Results Compared with group C,PaO2 at T3,T4,T5,T7,oxygenation index at T2,T3,T4,T7,and Cdyn at T2 were significantly increased in group P.Compared with group C,PaO2 at T3,T5,T6,oxygenation index at T2,T3,T4,T6,T7,and Cdyn at T2 were significantly increased in group R,while Ppeak was decreased at T2,T3,T4,T5.The time for achieving extubation standard,time for achieving the standard for discharge from PACU and duration of hospital stay were shortened in group P and group R compared to group C.Compared with group P,Ppeak was decreased and Cdyn was increased at T2,T3,T4.Postoperative pulmonary complications showed no difference among the three groups.Conclusion Intraoperative alveolar recruitment maneuver and PEEP after the protective ventilation maneuver can improve the intraoperative pulmonary function and promote the recovery of postoperative pulmonary function in the obese patients undergoing laparoscopic colorectal cancer radical prostatectomy.