摘要
摘要目的采用肺电阻抗成像法评价肺复张对腹腔镜胆囊切除术后早期肺通气的影响。方法选择择期行腹腔镜胆囊切除术患者30例，性别不限，年龄30-60岁，ASA分级Ⅰ或Ⅱ级，BMI 18-28 kg/m^2，采用随机数字表法分为2组（n＝15）：对照组（C组）和肺复张组（R组）。R组在气腹建立后5 min和气腹结束时进行手法肺复张，复张压力30 mmHg，持续30 s。于麻醉诱导前和气管拔管后实施肺电阻抗成像监测，记录中心通气区（CoV）、依赖静止区（DSS）、非依赖静止区（NSS）的面积百分比。结果2组CoV面积百分比、DSS面积百分比和NSS面积百分比比较差异无统计学意义（P〉0.05）。与麻醉诱导前比较，C组气管拔管后CoV面积百分比降低，DSS面积百分比和NSS面积百分比升高，R组气管拔管后DSS面积百分比和NSS面积百分比升高（P〈0.05），CoV面积百分比差异无统计学意义（P〉0.05）。结论肺复张可缓解腹腔镜胆囊切除术后早期局部肺通气下降，对肺不张和低通气无改善。
Objective To evaluate the effect of recruitment maneuver on early postoperative lung ventilation in patients undergoing laparoscopic cholecystectomy using electrical impedance tomography （EIT）.Methods Thirty American Society of Anesthesiologists physical status Ⅰor Ⅱ patients of both sexes, aged 30-60 yr, with body mass index of 18-28 kg/m2, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups （n=15 each） using a random number table： control group （group C） and recruitment maneuver group （group R）. Recruitment maneuver was performed with a pressure of 30 mmHg, lasting for 30 s, starting from 5 min after establishment of pneumoperitoneum and from the end of pneumoperitoneum in group R. EIT was carried out before anesthesia induction （baseline） and after extubation, and the percentages of area in center of ventilation （CoV）, dependent silent spaces （DSS） and non-dependent silent spaces （NSS） were recorded.Results There was no significant difference in the percentages of area in CoV, DSS or NSS between the two groups （P〉0.05）. Compared with the baseline before induction, the percentage of area in CoV was significantly decreased, and the percentages of area in DSS and NSS were increased after extubation in group C, and the percentages of DSS and NSS were increased （P〈0.05） and no significant change was found in the percentage of area in CoV in group R （P〉0.05）.Conclusion Recruitment maneuver can alleviate decrease in early postoperative regional lung ventilation, and it does not improve atelectasis and hypoventilation in patients undergoing laparoscopic cholecystectomy.
作者
李锐
孙玉红
李云
张野
Li Rui;Sun Yuhong;Li Yun;Zhang Ye(Department of Anesthesiology, Second Hospital of Anhui Medical University, Hefei 230601, China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2018年第3期271-273,共3页
Chinese Journal of Anesthesiology
基金
安徽省科技攻关项目（1704a0802165）
关键词
腹腔镜检查
肺通气
正压呼吸
体层摄影术
Laparoscopy
Pulmonary ventilation
Positive-pressure respiration
Tomography
