肺保护性通气策略在妇科腹腔镜手术中应用的临床观察

目的:通过监测肺顺应性、氧合指数、血浆白细胞介素-8(IL-8)值、血浆克拉拉细胞蛋白(CC16)值等指标,观察肺保护性通气策略是否可以改善妇科腹腔镜手术患者呼吸功能,降低肺损伤的发生。方法:选择40例美国麻醉医师协会体格情况评估分级(ASA分级)Ⅰ~Ⅱ级行择期腹腔镜宫颈癌根治术患者,采用随机数字表法将40例受试者分为两组。在全麻机械通气中,A组采用传统间歇正压通气模式,潮气量设置为10 ml/kg[理想体质量(PBW)];B组采用肺保护性通气策略,潮气量设置为6 ml/kg(PBW)+5 cm H_2O呼气末正压通气(PEEP)+手法肺复张。对患者气腹前(T_0)、气腹后2小时(T_1)、气腹后4小时(T_2)的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、呼吸频率(RR)、肺顺应性(C)进行观察;于T_0、T_1、T_2、手术后2小时(T_3)、手术后24小时(T_4)抽取血气,计算氧合指数(OI)值;分别在T_0、T_1、T_2、T_3、T_4抽取静脉血,检测血浆IL-8、血浆CC16值。结果:T_0时两组患者C比较,差异有统计学意义(P0.05);两组内T_1、T_2时点与T_0时比较,C均下降,差异有统计学意义(P0.05),A组下降均较B组明显(P0.05)。两组患者OI值在T_0、T_1、T_3、T_4时间点,差异有统计学意义(P0.05)。两组患者血浆IL-8、CC16值在T_1、T_2、T_3、T_4时点,差异有统计学意义(P0.05)。结论:肺保护性通气策略可能改善妇科腹腔镜手术患者呼吸功能,降低肺损伤的发生。

Clinical Observation of Lung Protective Ventilation Strategy in Gynecologic Laparoscopic Surgery

Objective:By monitoring the lung compliance,oxygenation index(OI),CC16、IL-8 in plasma,observe whether the protective lung ventilation in patients undergoing gynecological laparoscopic surgery can improve the respiratoryw function and reduce lung injury.Methods:40 cases of ASA grade Ⅰ-Ⅱ were selected,and 40 patients were treated by elective laparoscopic radical resection of cervical cancer.The patients were divided into two groups according to the random number table method in 40 cases.Mechanical ventilation in general anesthesia,A group used traditional intermittent positive pressure ventilation mode,tidal volume is set to 10ml/KG (PBW);B group used lung protective ventilation strategy,tidal volume is set to 6ml/KG (PBW) + 5cmH2O PEEP + recruitment manoeuvres.For patients before pneumoperitoneum(T0),2 hours after pneumoperitoneum (T1),4 hours after pneumoperitoneum (T2)MAP,HR,CVP,RR and C were observed.In pneumoperitoneum (T0),2 hours after pneumoperitoneum(T1),4 hours after pneumoperitoneum (T2),2 hours after operation(T3),24 hours after surgery(T4) venous,IL-8,CC16 content detection.Results:Before pneumoperitoneum,two groups of patients with pulmonary compliancethe difference was statistically significant(P ＜0.05).Compared T1 、T2 with T0 in A group and B group,the pulmonary compliance all decreased and there existed significant deference(P＜0.05).Notably,A group decreased evidently(P＜0.05).T0,T1,T3,T4 time points in two groups of patients with oxygenation index,the difference was statistically significant (P ＜ 0.05).Two groups of patients with CC16,IL-8content in T1,T2,T3,T4 time point,the difference was statistically significant (P ＜ 0.05).Conclusions:Lung protective ventilation strategy can improve respiratory function in patients with gynecological laparoscopic surgery,and reduce the incidence of lung injury.