麻醉诱导期不同通气方式对腹腔镜胆囊切除术患者术后恶心、呕吐的影响  

Effects of different ventilations during the induction of anesthesia on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

作　　者：朱学文[1] 李勇[1] 

机构地区：[1]南京医科大学鼓楼临床医学院麻醉科,210008

出　　处：《中国医师进修杂志》2016年第5期453-456,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的研究全身麻醉诱导期不同通气方式对腹腔镜胆囊切除术患者术后恶心、呕吐的影响。方法选择择期行腹腔镜胆囊切除术患者120例，按随机数字表法分为M组和v组，每组60例。M组患者全身麻醉诱导期采用手控辅助通气，操作均由同一名高年资主任医师完成；v组患者全身麻醉诱导期采用机控通气，根据潮气量不同再将V组进一步分为V1，V2及V3组，每组20例。V1组潮气量为体质量×4ml／kg，V2组潮气量为体质量×6ml／kg，V，组潮气量为体质量×8ml／kg，插管完毕后根据呼气末CO2分压（PETCO2，维持在35～45mmHg，1mmHg=0．133kPa）调整合适的潮气量完成手术。记录麻醉诱导期潮气量峰值、气道压峰值（Ppeak）、PETCO2、术中胃胀气及术后第1天恶心、呕吐的发生情况，并进行比较。结果V组患者术中胃胀气及术后第1天恶心、呕吐发生率明显高于M组[50．0％（30／60）比21．7％（13／60）、45．0％（27／60）比18．3％（11／60）、26．7％（16／60）比10．0％（6／60）]，差异有统计学意义（P〈0．05）。M组、V2和V3组麻醉诱导期Ppeak显著高于V1组[（13．55±1．95）、（12．05±1．23）、（18．35±3．71）cmH2O比（8．55±1．23）cmH2O，1cmH2O=0．098kPa]，PETCO2低于V1组[（19．60±4．31）、（27．75±1．94）、（23．60±4．45）mmHg比（29．90±2．40）mmHg]，差异均有统计学意义（P〈0．05）。结论腹腔镜胆囊切除术患者全身麻醉诱导期手控通气方式优于机控通气方式，能够减少术中胃扩张及术后恶心、呕吐的发生率；小潮气量、快通气频率在不同机控通气模式中能够降低术后恶心、呕吐发生率。Objective To investigate the effects of different ventilations during the induction of anesthesia on postoperative nausea and vomiting in patients undergoning laparoscopic cholecystectomy. Methods One hundred and twenty patients undergoing laparoscopic cholecystectomy were randomly divided into M group and V group according to random number table, 60 patients each group. The patients in M group performed manual ventilation and the patients in V group performed mechanical ventilation. According to different tidal volume, V group were randomly divided into three groups （20 patients each group： V1,V2 and V3 group, respectively recieved body weight ×4, 6 and 8 ml/kg. After tracheal intubation,the operations were completed by maintaining the end of CO2 partial pressure （PETCO2） from 35 to 45 mmHg, 1 mmHg = 0.133 kPa. Tidal volume, peak airway pressure （Ppeak） and PETCO2 in anesthesia induction,and intraoperative gastric insufflation and postoperative nausea and vomiting were recorded and compared. Results The incidence rate of gastric insufflation, postoperative nausea and vomiting in V group were significantly higher than those in M group： 50.0%（30/60） vs. 21.7% （13/60）, 45.0%（27/60） vs. 18.3%（11/60）, 26.7%（16/60） vs. 10.0%（6/60）, P 〈 0.05. The level of Ppeak in M group, V2 group and V3 group were signicantly higher than that in V1 group： （13.55 ± 1.95）,（12.05 ± 1.23）, （18.35 ± 3.71） cmH2O vs. （13.55 ± 1.95） cmH2O, 1 cmH2O = 0.098 kPa, P〈0.05. The level of PETCO2 in M group, V2 group and V3 group were signieantly lower than that in VI group： （19.60 ± 4.31）, （27.75 ± 1.94）, （23.60 ± 4.45） mmHg vs. （29.90 ± 2.40） mmHg, P〈 0.05. Conclusions Manual ventilation during the induction of anesthesia in patients undergoning laparoscopic eholecystectomy is better than mechanical ventilation . Proper manual positive pressure ventilation and volume mechanical ventilation with low tidal （4 ml/kg） may allow for decreasing intraoperative gas

关 键 词：麻醉 全身 胆囊切除术 腹腔镜 肠胃胀气 手术后恶心呕吐 

分 类 号：R614[医药卫生—麻醉学]