不同气腹压对腹腔镜手术患者呼吸功能的影响

目的观察不同气腹压对腹腔镜手术患者呼吸功能的影响。方法选择ASA分级Ⅰ-Ⅱ级拟择期行腹腔镜手术的全麻患者60例,随机分为Ⅰ组和Ⅱ组,每组30例。Ⅰ组患者术中设定气腹压1.33-1.55kPa,Ⅱ组患者术中设定气腹压1.06-1.20kPa。气管插管全麻后设定呼吸参数：潮气量（Vt）10mL/kg,RR 13次/min,吸呼比（I∶E）=1∶2。分别于气腹前（T0）、气腹后10min（T1）、气腹后20min（T2）和放气后10min（T3）记录患者的呼吸功能参数（Pmax、Pmean）,并采集动脉血、中心静脉血实验室检查PaO2、PaCO2值,并计算肺内分流（Qs/Qt）;根据气道压力计算动态肺顺应性（Cdyn）。对各时段呼吸功能监测和计算结果进行综合评价。结果与T0比较,T1、T2两组Pmax、Pmean、PaCO2、Qs/Qt均明显升高（P〈0.05）,PaO2、Cdyn明显下降（P〈0.05）;与Ⅱ组比较,Ⅰ组T1、T2各指标变化更明显（P〈0.05）。结论在满足手术操作视野需要的基础上,腹腔镜手术选择低气腹压对患者的呼吸系统影响小。

Effect of different pneumoperitoneum pressure on respiratory function of the patients undergoing laparoscopic surgery

Objective To discuss the effect of different pneumoperitoneum pressure on respiratory function of the patients undergoing laparoscopic surgery.Methods Sixty ASA I-Ⅱ patients scheduled for elective laparoscopic surgery were divided randomly into two groups（groupⅠand groupⅡ）with 30patients in each group.Pneumoperitoneum pressure of groupⅠ was set at 1.33-1.55kPa during operation,and that of groupⅡ was set at 1.06-1.20kPa.Respiratory parameters after general anaesthesia with tracheal intubation were set as follows：tidal volume was 10mL/kg,respiratory rate was 13times per minute,and inspiratory-expiratory ratio（I∶E）was 1∶2.Respectively at four time points：before insufflation（T0）,10min after insufflation（T1）,20min after insufflation（T2）,and 10min after deflation（T3）,we collected respiratory parameters（Pmax,Pmean）,detected PaO2,PaCO2volumes in arterial blood and central venous blood through experimental verification.We counted intrapulmonary shunt（Qs/Qt）,counted dynamic lung compliance through airway pressure.At last we comprehensively evaluated the data above.Results Pmax,Pmean,PaCO2and Qs/Qt at T1and T2were higher significantly than the data at T0（P〈0.05）,and PaO2and Cdyn at T1and T2were lower significantly than the data at T0（P〈0.05）.The change range between T0and T1,T2of groupⅠwas higher significantly than that of groupⅡ（P〈0.05）.Conclusion Low pneumoperitoneum pressure in laparoscopic surgery has little effect on patients＇ respiratory system when the visual field of surgical procedure is satisfied.