低潮气量通气联合肺复张对妇科腹腔镜手术患者肺氧合功能及动脉血气的影响

目的 分析妇科腹腔镜手术中低潮气量通气联合肺复张对患者肺氧合功能及动脉血气的影响。方法 选取马鞍山市人民医院2018年3月至2019年9月择期腹腔镜妇科手术患者70例,采用随机数字表法分为低潮气量组(L组,n=35)和对照组(C组,n=35)。气管插管后L组给予低潮气量通气,术中间断行手控肺复张;C组给予常规潮气量通气。检测两组患者在入室时(T₀)、气腹后10分钟(T₁)、30分钟(T₂)、60分钟(T₃)及停止气腹后10分钟(T₄)时动脉血气;观察并比较T₀～T₄时两组患者平均动脉压(MAP)、心率(HR)、呼末二氧化碳分压(PETCO₂)、气道峰压(Ppeak)、气道平台压(Pplat)、肺顺应性(CL)和术后通气相关不良反应,计算氧合指数(OI)和肺内分流率(Qs/Qt)情况。结果 L组T₂、T₃时MAP低于C组,差异有统计学意义(P<0.05);L组T₃时HR低于C组,差异有统计学意义(P<0.05);L组T₂、T₃时Ppeak、Pplat低于C组,T₂、T₃、T₄时CL高于C组,差异有统计学意义(P<0.05);L组T₁、T₂、T₃时二氧化碳分压(PaCO₂)、PETCO₂高于C组, T₂、T₃时Qs/Qt低于C组,差异有统计学意义(P<0.05);术后72 h内两组患者通气相关不良反应比较,差异无统计学意义(P>0.05)。结论 妇科腹腔镜手术中,L通气联合肺复张能够有效改善患者肺氧合功能,降低肺内分流,维持内环境稳定。

Effects of low tidal volume combined with lung recruitment maneuver on blood gases and oxygenation in patients undergoing gynecological laparoscopic surgery

Objective To observe the effects of low tidal volume combined with lung recruitment maneuver on blood gases and oxygenation in patients undergoing gynecological laparoscopic surgery. Methods A total of 70 female patients undergoing gynecological laparoscopy surgery were randomly divided into two groups, groupL and group C. Group L was given low tidal volume ventilation combined with lung recruitment maneuver;group C was given conventional tidal ventilation. The two groups received volume-controlled ventilation. Arterial blood gas was detected at the time of induction(T₀), 10min after pneumoperitoneum (T₁), 30min (T₂), 60min (T₃), 10min after release of pneumoperitoneum(T₄). MAP, HR, PETCO₂, Ppeak, Pplat, CL and postoperative complications were observed and compared between the two groups at T0~T4. The OI and Qs/Qt were calculated. Results MAP at T₂, T₃ point and HR at T3 point of group L were significantlylower than those of group C(P<0.05). Ppeak and Pplat at T2, T3 point of group L were significantly lower than those of group C(P<0.05). CL at T₂, T₃, T₄ point of group L was significantly higher than that of group C(P<0.05). PaCO₂ and PETCO₂ at T₁, T₂ and T₃ point of group L were significantly higher than those of group C(P<0.05). Qs/Qt at T₂, T₃ point of group L was significantly lower than that of group C(P<0.05). There was no significant difference in postoperative complications between the two groups within 72 hours after surgery(P>0.05). Conclusions The low tidal volume ventilation combined with lung recruitment maneuver can reduce pulmonary shunt fraction and improve oxygenation function during pneumoperitoneum and maintain cycle stability in patients undergoing gynecological laparoscopic surgery.