肥胖患者在侧卧位手术中应用双管喉罩行压力控制通气协同间歇性膨肺有效改善呼吸功能的研究

目的探讨双管喉罩应用于肥胖患者侧卧位手术中行压力控制通气协同间歇性膨肺对呼吸功能的影响。方法 40例需进行单侧肾切除的成年肥胖患者(BMI≥30且<36 kg/m2)随机分为2组(Ⅰ组和Ⅱ组)。两组患者均在麻醉诱导前行侧卧位,麻醉诱导后置入喉罩。Ⅰ组在压力控制通气模式中施加间歇性膨肺治疗(气道压30 cmH2O,持续时间为30 s),Ⅱ组只行压力控制通气模式。采集手术进行到45 min时的动脉血进行血气分析。结果一次性双管喉罩在所有侧卧位肥胖患者中均被成功置入。Ⅰ组行间歇性膨肺后肺顺应性和氧合能力均高于Ⅱ组(P<0.05)。两组患者在血流动力学方面的差异无统计学意义(P>0.05)。结论一次性双管喉罩可以安全有效地应用于侧卧位肥胖患者术中的气道管理,在术中行间歇性膨肺可以有效改善侧卧位肥胖患者的氧合能力和肺顺应性。

Research on the improvement of respiratory function through pressure-control ventilation with recruitment manoeuvres using LMA-Supreme~(TM) during operation in lateral position of adult obese patients

Objective To evaluate the effect of respiratory function through pressure-control ventilation with recruitment manoeuvres using LMA-SupremeTM(SLMA) during operation in lateral position of adult obese patients. Methods 40 adult obese patients undergoing unilateral nephrectomy(BMI≥30 and <36 kg/m2) were divided into two groups.They were all anesthetized after placing in the lateral position.Group Ⅰ applied pressure-control ventilation(PCV) with recruitment manoeuvres(RM)(30 cmH2O for 30 s).Group Ⅱ only applied pressure-control ventilation without RM.An arterial blood sample was taken after induction of anesthesia to 45 min. Results There were no failures of SLMA insertion and maintenance during surgery.Oxygenation and lung resistance in Group Ⅰ(with RM) were significantly higher than those in Group Ⅱ(without RM) during anesthesia(P<0.05).There was no significant difference in hemodynamics between the two groups(P>0.05). Conclusion SLMA can be safely and effectively used in the management of the airway of obese patients in the lateral position.RM can effectively improve oxygenation and lung resistance for obese patients in the lateral position.