肺保护性通气策略在妇科腹腔镜手术中应用的临床观察  

Clinical Observation of Lung Protective Ventilation Strategy in Gynecologic Laparoscopic Surgery

作　　者：蔡恒宇[1] 郜红艳[1] 

机构地区：[1]沈阳市妇婴医院麻醉科,辽宁沈阳110011

出　　处：《实用妇产科杂志》2017年第7期534-537,共4页Journal of Practical Obstetrics and Gynecology

基　　金：沈阳市卫计委科研基金资助项目(编号:2015-06)

摘　　要：目的:通过监测肺顺应性、氧合指数、血浆白细胞介素-8(IL-8)值、血浆克拉拉细胞蛋白(CC16)值等指标,观察肺保护性通气策略是否可以改善妇科腹腔镜手术患者呼吸功能,降低肺损伤的发生。方法:选择40例美国麻醉医师协会体格情况评估分级(ASA分级)Ⅰ~Ⅱ级行择期腹腔镜宫颈癌根治术患者,采用随机数字表法将40例受试者分为两组。在全麻机械通气中,A组采用传统间歇正压通气模式,潮气量设置为10 ml/kg[理想体质量(PBW)];B组采用肺保护性通气策略,潮气量设置为6 ml/kg(PBW)+5 cm H_2O呼气末正压通气(PEEP)+手法肺复张。对患者气腹前(T_0)、气腹后2小时(T_1)、气腹后4小时(T_2)的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、呼吸频率(RR)、肺顺应性(C)进行观察;于T_0、T_1、T_2、手术后2小时(T_3)、手术后24小时(T_4)抽取血气,计算氧合指数(OI)值;分别在T_0、T_1、T_2、T_3、T_4抽取静脉血,检测血浆IL-8、血浆CC16值。结果:T_0时两组患者C比较,差异有统计学意义(P<0.05);两组内T_1、T_2时点与T_0时比较,C均下降,差异有统计学意义(P<0.05),A组下降均较B组明显(P<0.05)。两组患者OI值在T_0、T_1、T_3、T_4时间点,差异有统计学意义(P<0.05)。两组患者血浆IL-8、CC16值在T_1、T_2、T_3、T_4时点,差异有统计学意义(P<0.05)。结论:肺保护性通气策略可能改善妇科腹腔镜手术患者呼吸功能,降低肺损伤的发生。Objective： By monitoring the lung compliance, oxygenation index （ OI ）, CC16 、 IL-8 in plasma, ob- serve whether the protective lung ventilation in patients undergoing gynecological laparoscopic surgery can im- prove the respiratory function and reduce lung injury. Methods ：40 cases of ASA grade I- II were selected, and 40 patients were treated by elective laparoscopic radical resection of cervical cancer. The patients were divided in- to two groups according to the random number table method in 40 cases. Mechanical ventilation in general anes- thesia,A group used traditional intermittent positive pressure ventilation mode, tidal volume is set to 10ml/KG （PBW） ;B group used lung protective ventilation strategy, tidal volume is set to 6ml/KG （PBW） ＋ 5cmH20 PEEP ＋ recruitment manoeuvres. For patients before pneumoperitoneum （To ） ,2 hours after pneumoperitoneum （T1） ,4 hours after pneumoperitoneum （ T2 ） MAP, HR, CVP, RR and C were observed. In pneumoperitoneum （T0 ） ,2 hours after pneumopefitoneum（T1 ） ,4 hours after pneumoperitoneum（T2 ） ,2 hours after operation（T3 ）, 24 hours after surgery（T4 ） venous, IL-8, CC16 content detection. Results ： Before pneumoperitoneum, two groups of patients with pulmonary compliancethe difference was statistically significant（ P 〈 0.05）. Compared T1 ,T2 with TO in A group and B group,the pulmonary compliance all decreased and there existed significant deference（ P 〈 0.05）. Notably,A group decreased evidently（P〈0.05）. T0 ,T1 ,T3 ,T4 time points in two groups of patients with oxygenation index,the difference was statistically significant（ P 〈 0.05）. Two groups of patients with CC16, IL-8content in T1, T2, T3, T4 time point, the difference was statistically significant （ P 〈 0. 05 ）. Conclusions： Lung protective ventilation strategy can improve respiratory function in patients with gynecological laparoscopic surgery, and reduce the incidence of lung injury.

关 键 词：肺保护性通气策略 肺损伤 腹腔镜 宫颈癌 

分 类 号：R737.33[医药卫生—肿瘤]