气管插管后行过度通气对后腹腔镜手术患者术中肺功能的影响

目的 探究气管插管后行过度通气对后腹腔镜手术患者肺功能的影响。方法 选择择期行后腹腔镜手术患者44例，采用数字表法随机分为对照组（C组，n=22）和实验组（P组，n=22）。两组均采用间歇正压通气模式，吸入氧浓度为100%，氧流量为2L/min，吸呼比为1∶1.5。C组：气管插管后至气腹前行正常通气：潮气量10ml/kg，频率12次/分，气腹开始后改为潮气量8ml/kg，频率18次/分直至术毕。P组：气管插管后至术毕全程均行过度通气：潮气量8ml/kg，频率18次/分。记录诱导前（T₀）、气腹前（T₁）、气腹10min（T₂）、气腹30min（T₃）、气腹1h（T₄）、气腹结束（T₅）时的气道峰压、呼气末二氧化碳分压，并于上述各时间点分别行动脉血气分析，计算肺动态顺应性（Cdyn）、氧合指数（OI）、呼吸指数（RI）和肺泡-动脉血氧分压差（A-aDO₂）。结果 与C组比较，P组T_1~5时的呼气末二氧化碳分压及动脉血二氧化碳分压降低，T_1~4时气道峰压均降低，T_2~5时动态肺顺应性增高，拔除气管导管时间缩短（P<0.05）。与C组比较，各时间点两组的氧和指数、呼吸指数、肺泡-动脉氧分压差及皮下气肿、术后低氧血症发生率、住院天数比较差异无统计学意义（P>0.05）。结论 气管插管后即刻行过度通气有利于减轻后腹腔镜手术中的二氧化碳蓄积，同时对肺功能有一定的保护作用。

Effect of Hyperventilation after Intubating Endotracheal Tube on Pulmonary Function in Patients Undergoing Retroperitoneoscopy Surgery

Objective To evaluate the effect of hyperventilation after intubating endotracheal tube on intraoperative pulmonary function in patients undergoing retroperitoneoscopy surgery. Methods Forty-four patients undergoing elective retroperitoneoscopy surgery were divided into two groups(n=22 each)using a random number table:control group(group C)and experiment group(group P). All the patients received intermittent positive ventilation. The oxygen concentration was 100% and oxygen flow rate was 2L/min,the inhalation and exhalation ratio was 1:1.5. Group C:the tidal volume(V_T) was set 10ml/kg and respiratory rate(RR) was 12 times/min after intubating endotracheal tube. After the carbon dioxide pneumoperitoneum, the patients were ventilated V_T 8ml/kg and RR 18 times/min. Group P:after intubating endotracheal tube, the patients were given V_T 8ml/kg and RR 18 times/min until the end of the surgery. Peak airway pressure(P_PEAK), end tidal carbon dioxide pressure(P_ETCO₂) were recorded at induction(T₀), before pneumoperitoneum(T₁), at 10,30,60 min of pneumoperitoneum(T_2-4), the end of pneumoperitoneum(T₅). The arterial blood gas was also analyzed and dynamic lung compliance(Cdyn), oxygenation index(OI), respiratory index(RI) and difference of alveoli-arterial oxygen pressure(A-aDO₂) were calculated. Results Compared with group C,tidal carbon dioxide pressure and arterial blood carbon dioxide partial pressure were significantly lower at T_1-5,peak airway pressure was significantly lower at T_1-4,dynamic lung compliance was significantly higher at T_2-5, the time of removal of endotracheal tube was significantly shorter(P<0.05). There was no significant change in oxygenation index, espiratory index and difference of alveoli-arterial oxygen pressure at each time point(P>0.05) in group P as well as the incidence of subcutaneous emphysema, postoperative hypoxemia and hospitalization days. Conclusion Hyperventilation after intubating endotracheal tube in the patients can decrease the absorption of carbon dioxide and increase the dynamic lung compliance in retroperitoneoscopy surgery.