预先肺复张策略结合肺保护通气对老年患者腹腔镜手术中动脉血氧合作用及呼吸力学的影响
投稿时间:2015-10-03  修订日期:2015-10-20  点此下载全文
引用本文:钟媛,李新白,耿娜,韩伟.预先肺复张策略结合肺保护通气对老年患者腹腔镜手术中动脉血氧合作用及呼吸力学的影响[J].医学研究杂志,2016,45(4):138-141
DOI: 10.11969/j.issn.1673-548X.2016.04.036
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钟媛 130021 长春, 吉林大学白求恩第一医院麻醉科  
李新白 130021 长春, 吉林大学白求恩第一医院麻醉科  
耿娜 130021 长春, 吉林大学白求恩第一医院麻醉科  
韩伟 130021 长春, 吉林大学白求恩第一医院麻醉科 zhongyuan0906@126.com 
中文摘要:目的 探讨在老年患者行腹腔镜胃癌根治手术中,预先肺复张策略结合肺保护通气对动脉血氧合作用及呼吸力学的影响。方法 选取择期行腹腔镜下胃癌根治术的患者80例,患者年龄65~79岁,ASA分级Ⅰ~Ⅲ级。分为4组(n=20),8ml/kg潮气量组(H组),8ml/kg潮气量结合预先肺复张策略组(H-ARS组),6ml/kg潮气量结合5cmH2O的呼气末正压组(L组),以及6ml/kg潮气量加5cmH2O的呼气末正压结合预先肺复张策略组(L-ARS组)。测定插管后10min(T0)、ARS后10min(T1)、气腹后10min(T2)、气腹后30min(T3)、气腹结束后10min(T4)的呼气末CO2分压(PETCO2)、气道峰压(Ppeak)、平均气道压(Pmean),并计算肺动态顺应性(Cdyn)。分别各时点抽取动脉血监测血气,并根据动脉血氧分压(PaO2)、动脉血CO2分压(PaCO2)、吸人氧浓度(FiO2)等计算氧合指数、呼吸指数、肺泡动脉血氧分压差(A-aDO2)。结果 H-ARS组与H组比较,L-ARS组与L组比较,氧合指数均较高(P<0.05)。H-ARS组的氧合指数最高。H组与L-ARS组的氧合指数相近,而且都显著高于L组。H-ARS组的气道平台压显著高于L-ARS组(P<0.05)。结论 预先肺复张策略可以提高患者腹腔镜手术中的动脉血氧合作用,预先肺复张策略结合肺保护通气可以改善肺泡动态顺应性、减少高潮气量引起的肺损伤。
中文关键词:腹腔镜  老年患者  预先肺复张策略  潮气量  呼气末正压
 
Effects of a Preemptive Alveolar Recruitment Strategy Combined with Lung Protective Ventilation on Arterial Oxygenation and Breathing Mechanics During Laparoscopic Surgery in Elderly Patients with Different Tidal Volumes
Abstract:Objective To investigate the effect of a preemptive alveolar recruitment strategy combined with lung protective ventilation on arterial oxygenation and breathing mechanics during selective laparoscopy-assisted radical gastrectomy in elderly patients. Methods In total, 80 ASA Ⅰ to Ⅲ patients undergoing selective laparoscopy-assisted radical gastrectomy for gastric cancer, aged 65-79 yr, were randomized into four groups comprising 20 patients each:those administered a 8 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 5cmH2O PEEP(positive end expiratory pressure) with or without preemptive ARS (Group L and Group L-ARS, respectively). PETCO2, Ppeak, Pmean, and calculate the Cdyn, arterial blood gas at 10min after intubation (T0), 10min after ARS (T1), 10min after the began of pneumoperitoneum (T2), 30 min after the began of pneumoperitoneum (T3), 10 min after the end of pneumoperitoneum (T4) were measured respectively, and according to the PaO2, PaCO2 and FiO2 oxygenation index, respiratory index, A-aDO2 were calculated. Results Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P<0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during selective laparoscopy-assisted radical gastrectomy, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P<0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P<0.05). Conclusion Preemptive ARS can improve arterial oxygenation during selective laparoscopy-assisted radical gastrectomy. Furthermore, a 6 ml/kg tidal volume combined with 5 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during selective laparoscopy-assisted radical gastrectomy.
keywords:Selective laparoscopy-assisted radical gastrectomy  Gerontal patients  Preemptive alveolar recruitment  Tidal volume  PEEP
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