呼气末正压通气对二氧化碳气腹期间病人肺内分流的影响  

Effect of positive end-expiratory pressure on intrapulmonary shunt during pneumoperitoneum

作　　者：冯梅[1] 蒋宗滨[1] 马相飞[1] 冼海燕[1] 陈丽妮[1] 黄子津[1] 张夏[1] 张明明[1] 

机构地区：[1]广西医科大学第一附院西院手术室麻醉科,530007

出　　处：《临床麻醉学杂志》2007年第7期552-554,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察二氧化碳气腹期间不同呼气末正压通气(PEEP)对肺内分流的影响。方法35例ASAⅠ或Ⅱ级经腹腔镜行中、上腹部手术的病人,随机分为P0组(不予PEEP)、P1组(予4mm Hg PEEP)、P2组(予7mm Hg PEEP)及P3组(予9mm Hg PEEP)。观察注气前5min、注气后30、60、120min的SBP、DBP、HR、SpO2、PETCO2及血气分析。结果与注气前5min比较,四组注气后30min SBP、DBP均显著增高、HR均显著增快(P<0.05或P<0.01);P3组注气后60、120min仍高于注气前(P<0.05或P<0.01),并且其HR、DBP高于P0组(P<0.05或P<0.01)。P0、P1、P3三组注气后PaCO2、动脉血-呼气末二氧化碳分压差(Pa-ETCO2)、肺泡氧分压-动脉血氧分压差(A-aDO2)均显著增高(P<0.05或P<0.01),PaO2注气后30、120min显著降低(P<0.05或P<0.01);P2组差异无统计学意义,并且其PaO2高于P0组,PaCO2、Pa-ETCO2、A-aDO2均低于P0组(P<0.05或P<0.01)。P2、P3两组注气后吸气峰压(Ppeak)均显著增高(P<0.01),并高于P0组(P<0.05或P<0.01)。结论气腹期间采用7mm Hg PEEP的通气模式能有效改善肺的换气功能,且对循环功能的影响较小。Objective To investigate the effect of positive end-expiratory pressure （PEEP） on intrapulmonary shunt during pneumoperitoneum. Methods Thirty-five ASA Ⅰ or Ⅱpatients undergoing laparoscopic operation of upper-abdominal and middle- abdominal region were randomly allocated to four groups with 10 cases in former three groups and 5 in the last. The patients in group P1 were given a constant PEEP of 4 mmHg. The application of PEEP in group P2 and group P3 were respectively 7 mmHg and 9 mmHg, while no PEEP was applied in group P0 during mechanical ventilation. SBP,DBP, HR, SpO2, PRT CO2, inspiratory peak pressure （Ppeak） and arterial blood gas recorded at the following time points., before pneumoperitoneum,at 30 min,60 min, and 120 min into pneumoperitoneum. Results SBP,DBP and HR increased significantly （P〈0.05 or P〈0. 01）at 30 min compared to before inflation in four groups,DBP and HR still increased significantly （P〈0. 05 or P〈0. 01）at 60 and 120 min in group P3 and were more than those in group P0 （P〈0. 05 or P〈0. 01）. PaCO2, arterial-end-expired CO2 difference （Pa-ErCO2） and alveolar-arterial oxygen difference （A-aDO2） increased significantly at 30,60 and 120 min,and PaO2 at 30 and 120 min after inflation in group P0 ,P1 and P3 （P〈0.05 or P〈0.01）, while those did not change significantly in group P2 and were less than those in group P0 （P〈0.05 or P〈0.01）. PaO2 in group P2 were more than those in group P0 （P〈0. 05 or P〈0.01）. Ppeak increased significantly after inflation in group P2 and P3 and were more than those in group P0 （P〈0.-05 or P〈0. 01）. Conclusion A constant PEEP of 7 mmHg improves intrapulmonary shunt and oxygenation during pneumoperitoneum without depression of hemodynamics.

关 键 词：腹腔镜 气腹 呼气末正压通气 氧合 

分 类 号：R614[医药卫生—麻醉学]