序贯肺复张后肺保护性通气在腹腔镜结直肠手术中对呼吸力学和预后的影响

目的观察腹腔镜结直肠手术麻醉期间,肺保护性通气联合不同方法肺复张后对呼吸力学和预后的影响。方法选择腹腔镜结直肠手术患者62例,男37例,女25例,年龄46~72岁,BMI 17~27 kg/m 2,ASAⅠ—Ⅲ级。随机分为三组:序贯肺复张组(XG组,n=20)、随机肺复张组(SJ组,n=21)和无肺复张组(DZ组,n=21)。三组均进行肺保护性通气,XG组摆Trendlenburg体位后进行第1次肺复张,以后每小时用PEEP递增法肺复张1次;SJ组摆Trendlenburg体位后进行第1次肺复张,气腹停止后进行第2次肺复张;DZ组全程不进行肺复张。记录插管后、第1次肺复张后即刻,第1次肺复张后60、120 min、拔管前的气道峰压(Ppeak)、驱动压(ΔP);记录术后肺部感染、恶心呕吐发生情况和住院时间。结果与插管后比较,第1次肺复张后即刻、第1次肺复张后60、120 min三组Ppeak、ΔP明显升高(P<0.05)。与拔管前比较,第1次肺复张后即刻、第1次肺复张后60、120 min三组Ppeak、ΔP明显升高(P<0.05)。XG组和SJ组第1次肺复张后即刻、第1次肺复张后60、120 min Ppeak、ΔP明显低于DZ组(P<0.05)。XG组第1次肺复张后120 min Ppeak、ΔP明显低于SJ组(P<0.05)。术后DZ组有1例肺部感染。三组住院时间差异无统计学意义。结论对腹腔镜结、直肠手术无肺部疾病的患者进行肺复张能改善肺保护性通气的驱动压和肺效率。肺复张可作为肺保护性通气的有效补充。

Effect of sequential lung recruitment maneuvers combined with protective ventilation on respiratory mechanics and prognosis of laparoscopic colorectal surgery

Objective To observe the effect of protective lung ventilation combined with different lung recruitment maneuvers on respiratory mechanics and prognosis of laparoscopic colorectal surgery during anesthesia.Methods Sixty-two patients undergoing laparoscopic colorectal surgery were included,37 males and 25 females,aged 46-72 years,BMI 17-27 kg/m 2,ASA physical statusⅠ-Ⅲ.They were randomly divided into three groups:sequential lung recruitment maneuver(group XG,n=20),random lung recruitment maneuver(group SJ,n=21)and non-lung recruitment maneuver group(group DZ,n=21),Protective lung ventilation was performed in all patients.In group XG,the first lung recruitment maneuver was performed after the patients were tilted to Trendlenburg position,and lung recruitment was performed every hour after that by the method of increasing PEEP.In group SJ,the first lung recruitment maneuver was performed after the Trendlenburg position was posed,and the second lung recruitment maneuver was performrmed after the stop of pneumoperitoneum,the method of each lung recruitment maneuver was the same as that of group XG.In group DZ,lung recruitment maneuver was not used in the whole course.The changes of peak airway pressure(Ppeak)and respiratory drive pressure(Ppeak-PEEP,ΔP)after intubation,immediately after the first lung recruitment after placing the Trendlenburg position,60 and 120 minutes after the first lung recruitment maneuver and before extubation were recorded and compared.The incidence of postoperative pulmonary infection,incidence of nausea and vomiting and length of hospital stay were recorded.Results Immediately after the first lung recruitment,and 60 and 120 minutes after the first lung recruitment maneuver,the Ppeak andΔP were significantly higher than the ones after intubation(P<0.05);immediately after the first lung recruitment,and 120 minutes after the first lung recruitment maneuver,the Ppeak andΔP were significantly higher than the ones before extubation(P<0.05);Immediately after the first lung recruitment,and 60 minutes and 120 minutes after the first lung recruitment maneuver,Ppeak andΔP of groups XG and SJ were significantly lower than those of group DZ(P<0.05).Ppeak andΔP of group XG were significantly lower than those of group SJ at 120 minutes after the first lung recruitment maneuver(P<0.05).There was only one case of pulmonary infection in the group DZ.There was no significant difference in length of stay among the three groups.Conclusion Lung recruitment maneuver in laparoscopic colorectal surgery patients without lung disease can improve the driving pressure and lung efficiency of pulmonary protective ventilation.Lung recruitment maneuver can be an effective supplement to pulmonary protective ventilation.