腹腔镜手术中不同体重指数患者气道压力和肺部感染的比较  

Effects ofpneumoperitoneum on the airway pressure and pulmonary infection of patients with different body mass index in laparoscope

作　　者：陈元朝 苗韶华 赵蔚[3] 王月兰[3] 

机构地区：[1]山东省鄄城县人民医院麻醉科,250000 [2] 山东省菏泽市人民医院麻醉科 [3] 山东大学附属千佛山医院麻醉科

出　　处：《临床麻醉学杂志》2015年第12期1202-1204,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨不同体重指数患者气腹对患者气道压力和术后肺部感染的影响。方法全麻腹腔镜手术患者849例,在BIS和TOF肌松监测下,采用丙泊酚、瑞芬太尼全凭静脉麻醉,术中采用平卧位、头高位或头低位手术,观察患者气道压力改变以及术后1周内的肺部感染情况。结果 BMI<30kg/m^2患者在同一气腹压力,头低位时气腹后气道压力明显增加(P<0.05);不同体位患者BMI>30kg/m^2时气腹后气道压力明显增加(P<0.05);所有患者肺部感染率无明显增加。结论头低位和BMI>30kg/m^2可导致气道压升高,增加术后肺感染率,对上述患者尽量缩短手术时间,调整呼吸通气模式,降低气腹压力和加强术后肺部感染的预防。Objective To make clear the patients in minimally invasive surgery through explo-ring effects of pneumoperitoneum and pulmonary infection on the airway pressure of patients with dif-ferent body mass index （BMI）under general anesthesia.Methods A total of 849 cases of patients with trachea cannula in pneumoperitoneum surgery inr general anesthesia under different position were studied.To observe the changes of airway pressure and the ratio of pulmonary infection within one week of patients in general anesthesia.Propofol,Remifentanil and Atracrium were used in general an-esthesia.BIS and TOF were used to detect the degree of muscle relaxation.Results The airway pres-sure was increased obviously in patients of Head-down Tilt under same pneumoperitoneum pressure（P〈0.05）;the airway pressure was increased in patients with BMI〉 kg/m2 （P 〈0.05）.There was no obvious increase in pulmonary infection rate in all patients.Conclusion Pneumoperitoneum could increase airway pressure and pulmonary infection of patients with low head position and BMI 〉 30 kg/m2 under same pneumoperitoneum pressure.Therefore,shorten the operation time and decreased pneumoperitoneum pressure could be used to prevent pulmonary infection.

关 键 词：腹腔镜手术 体位 气道压力 肺部感染 体重指数 

分 类 号：R614[医药卫生—麻醉学]