摘要
目的探讨腹腔镜手术气腹头低位时,肺开放策略[肺复张(RM)联合呼气末正压(PEEP)]对呼吸力学的影响。方法选择34例腹腔镜下行直肠癌根治术患者,气腹后RM随后机械通气联合5cmH2O PEEP直至手术结束。测定气腹前、气腹后15min头低足高位25°无PEEP、RM后5cmH2O PEEP和气腹结束时的呼吸力学指标、血流动力学参数和动脉血气。结果气腹和头低足高位显著增加E CW和E L,分别为8.5±0.8和11.89±1.75cmH2O/L,与T0比较有统计学差异(P<0.05,P<0.01);与T0比较,OLS能明显降低E CW和E L,分别为5.3±1.4和8.65±1.03cmH2O/L(P<0.05)。T1吸气末跨肺压(Pplat L)和呼气末跨肺压(PEEPtotal L)分别为9.22±2.03和2.8±1.7cmH2O较T0明显降低(P<0.05,P<0.01),而在T2显著上升,分别为11.65±1.25和6.55±1.30cmH2O。T2时点PaO2/FiO2均低于其他时点(P<0.05)。RM引起每搏输出量短暂下降。结论 OLS可增加跨肺压进而开放塌陷肺泡,降低胸壁弹性阻力,改善肺气体交换。
Objective To assess the effects of open lung strategy [alveolar recruitment followed by positive end-expiratory pressure （PEEP）] on the respiratory mechanics and arterial oxygenation during laparoscopy assisted colorectectomy.Methods In 34 consecutive patients,a recruiting maneuver followed by PEEP 5cmH2O maintained until the end of surgery was applied after pneumoperitoneum induction.Respiratory mechanics,gas exchange,blood pressure,and cardiac index were measured before （T0） and after pneumoperitoneum with zero PEEP （T1）,after recruitment with PEEP 5cmH2O （T2）,and after peritoneum desufflation with PEEP 5cmH2O （T3）.Results Chest wall elastance （Ecw） and elastance of the lung （EL） in T1 were markedly increased （8.5 ± 0.8 vs 11.89 ± 1.75cmH2O/L） comapred to T1 under pneumoperitoneum and Trendlenburg position.Whereas,ECW and EL were ameliorated after initiation of open lung strategy in T2.Similarly,end-inspiratory transpulmonary pressure （PplatL） and end-expiratory transpulmonary pressure （PEEPtotalL）were decreased in T1.And PaO2/inspiratory oxygen fraction improved through implemetation of alveolar recruitment remaining stable thereafter.There was sharp and transient decrease in stroke volume at the time of alveolar recruitment.All respiratory mechanics parameters remained stable after abdominal desufflation.Hemodynamic parameters remained stable throughout the study.Conclusion An open lung strategy applied after pneumoperitoneum induction confers beneficial effects on respiratory mechanics with ameliorated airway pressure,reexpand collapsed alveoli,increased transpulmonary pressure,decreased chest wall elastance and improved gas exchange inpatients submitted to laparoscopic surgery in Trendelenburg position.
出处
《医学研究杂志》
2013年第9期128-131,共4页
Journal of Medical Research
关键词
肺复张
呼气末正压
呼吸力学
Alveolar recruitment
Positive end- expiratory pressure
Respiratory mechanics
