肺保护性通气策略对腹腔镜妇科手术肥胖患者肺功能的影响  

Effect of lung protective ventilation strategy on lung function in obese patients undergoing gynecological laparo⁃scopic surgery

作　　者：王华 黄新华 刘静 WANG Hua;HUANG Xinhua;LIU Jing(Department of Anesthesiology,Huzhou Maternity&Child Health Care Hospital,Huzhou 313000,China)

机构地区：[1]湖州市妇幼保健院麻醉科,浙江湖州313000

出　　处：《全科医学临床与教育》2020年第5期415-418,共4页Clinical Education of General Practice

基　　金：湖州市科技局公益类项目(2019GYB55);浙江省医药卫生科技计划(2020KY932)。

摘　　要：目的 评价肺保护性通气策略(LPVS)对腹腔镜妇科手术肥胖患者肺功能的影响.方法 选择60例体重指数≥30 kg/m2择期拟行腹腔镜妇科手术患者,采用随机数字表法分为两组:肺保护性机械通气组(观察组)和常规容量控制间歇正压机械通气组(对照组).比较两组患者气腹前(T1)、气腹后1 h(T2)、气腹后2 h(T3)、气腹停止5 min时(T4)的气道峰压(Ppeak)、平台压(Pplat)、肺动态顺应性(Cdyn)及血清白介素-8(IL-8)、血清人克拉拉细胞蛋白16(CC16)、肺泡表面活性物质-D(SP-D)浓度,以及术后5 d内肺部并发症的发生情况.结果 观察组患者在T2~T4时Ppeak、Pplat低于对照组,Cdyn高于对照组,差异均有统计学意义(t分别=5.84、6.12、7.23、8.63、9.35、8.73、6.98、6.37、7.38,P均<0.05).观察组患者在T2~T4时IL-8、CC16和SP-D均低于对照组,差异均有统计学意义(t分别=5.89、7.23、6.37、7.01、8.33、7.87、6.39、5.88、6.20,P均<0.05).观察组患者的术后5 d内肺部并发症发生率低于对照组,差异有统计学意义(χ2=4.29,P<0.05).结论 LPVS能改善腹腔镜妇科手术肥胖患者肺功能,降低术后早期肺部并发症.Objective To investigate the effect of lung protective ventilation strategies on lung injury in obese patients undergoing gynecological laparoscopic surgery.Methods Sixty patients scheduled for elective laparoscopic gynecological surgery whose BMI larger than 30 kg/m2 were selected and randomly divided into two groups:lung protective ventilation group(observation group)and conventional ventilation group(control group).At times before pneumoperitoneum(T1),1 hours after pneumoperitoneum(T2),2 hours after pneumoperitoneum(T3)and 5 minutes after pneumoperitoneum completed(T4),the peak airway pressure(Ppeak),plateau airway pressure(Pplat)and lung dynamic compliance(Cdyn)were recorded as well as the interleukin-8(IL-8),club cell protein 16(CC16)and surfactant protein-D(SP-D)were detected.The incidence of pulmonary complications were recorded between two groups within 5 days after surgery.Results Compared with the control group,the Ppeak,Pplat were significantly decreased and the Cdyn was significantly higher at T2-T4 in observation group(t=5.84,6.12,7.23,8.63,9.35,8.73,6.98,6.37,7.38,P<0.05).Compared with the control group,the IL-8,CC16,and SP-D were declined at T2-T4 in observation group(t=5.89,7.23,6.37,7.01,8.33,7.87,6.39,5.88,6.20,P<0.05).The incidence of pulmonary complications within 5 days after surgery in observation group was lower than that in control group(χ2=4.29,P<0.05).Conclusion Lung protective ventilation strategy can protect the lung function and reduce the incidence of pulmonary complications in obese patients undergoing laparoscopic gynecological surgery.

关 键 词：肺保护性通气策略 腹腔镜 肥胖 肺功能 

分 类 号：R713[医药卫生—妇产科学]