气腹性肺损伤的机制与防治策略

背景 腹腔镜手术具有创伤小、恢复快等特点.但手术过程中建立CO2气腹会造成腹腔内高压和酸碱平衡失调,引起不同程度的肺组织损伤,导致术后肺功能不全,严重者甚至可以发展为急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS). 目的 阐述气腹性肺损伤的机制和防治研究新进展. 内容 气腹性肺损伤的发生机制很复杂,可由通气/血流比例失调、氧化和抗氧化系统失衡、缺血/缺氧、缺血/再灌注损伤、促炎和抗炎反应失衡等因素引起.通过小潮气量联合呼气末正压通气的肺通气模式,允许性高碳酸血症,气腹前预处理和药物的应用可以减轻气腹引起的肺损伤. 趋向 通过对CO2气腹引起肺损伤的发生机制及防治策略进行综述,期望为气腹性肺损伤的预防及治疗提供新的思路.

Mechanism and progress of prevention and treatment of lung injury induced by pneumoperitoneum

Background Laparoscopic surgery has many advantages,such as mild trauma,rapid recovery and so on.But artificial CO2 pneumoperitoneum will increase the abdominal cavity pressure and cause acid-base balance disorder,leading to different degree of lung injury even acute respiratory distress syndrome (ARDS).Objective The review summarized the mechanism and new progress of prevention and treatment in lung injury caused by pneumoperitoneum.Content Mechanism of lung injury cause by pneumoperitoneum is complex,including imbalance of V/Q ratio,the oxidation/anti-oxidation system and pro-inflammatory/antiinflammatory responses.Ischemia,hypoxia,ischemia-reperfusion injury may also involved.Combination of positive end expiratory pressure and small tidal volume,hypercapnia permission,pretreatment of pneumoperitoneum and the application of medicines can reduce the lung injury caused by pneumoperitoneum.Trend Advanced study on the mechanism of lung injury caused by CO2 pneumoperitoneum and therapeutic strategy provide new insights for prevention and treatment of pneumoperitoneum induced lung injury.