全麻诱导期呼气末正压通气对肥胖患者腹腔镜胆囊切除术后呼吸功能和肺不张的影响

目的 探讨全麻诱导期呼气末正压通气对肥胖患者腹腔镜胆囊切除术后呼吸系统功能和并发症的影响.方法 择期全麻下行腹腔镜胆囊手术的肥胖患者（BMI ＞30 kg/m2）64例,年龄29～62岁,ASA I或Ⅱ级,随机分为A、B两组,每组32例,A组患者仅在术中加用呼气末正压通气（PEEP=8 mmHg）,B组患者在麻醉诱导期开始便加用呼气末正压通气（PEEP=8 mmHg）.两组患者麻醉诱导期、维持期及其他处理因素相同.记录手术麻醉前（T0）、气腹后1 h（T1）、气管拔管后1 h（T2）的心率（HR）、平均动脉压（MAP）、血氧分压（PaO2）和二氧化碳分压（PaCO2）的变化情况,记录4hX线胸片肺不张发生率.结果 与T0时比较,B组T1时PaO2显著增高（P＜0.05）;与A组比较,B组T1和T2时PaCO2明显升高,HR、MAP明显降低及拔管后4hX线胸片显示肺不张发生率显著降低（P＜0.05）.结论 麻醉诱导早期开始使用PEEP对肥胖患者全身麻醉术后发生低氧血症和高二氧化碳血症有很好的预防作用,减少肺不张的发生率.

Influence of PEEP in the induction of anesthesia on the postoperative respiratory function and atelectasis of obese patients with laparoscopic cholecystectomy

Objective To investigate the influence of PEEP in the induction of anesthesia on the postopera- tive respiratory function and complications of obese patients with laparoscopic cholecystectomy. Methods Sixty-four ASA I or II obese patients aged 29-62 years old undergoing laparoscopic gallbladder operation under general an- esthesia were randomly allocated into two groups： group A （n=32） applied PEEP during operation （PEEP=8 mmHg） and group B applied PEEP during induction of anesthesia （PEEP=8 mmHg）. HR MAP, PaO2, and PaCO2 were monitored be- fore anesthesia （To）, 1 h after pneumoperitoneum （Ta）, 1 h after extubation （T2）, and the X-ray of 4 h after extubation and ad- verse reactions of the two groups were also observed. Results PaO2 at T1 and T1 was significantly increased in group B compared with those at To （P〈0.05）. Compared with group A, PaCO2, HR, MAP at T1 and T2 and the rate of atelectasis in X-ray of 4 h after extubation was significantly decreased （P〈0.05）, while PaO2 was significantly increased （P〈 0.05）. Conclusion Application of PEEP in the induction of anesthesia for obese patients with laparoscopic general anesthesia can prevent and control postoperative hypoxemia, hypercapnia and pulmonary atelectasis.