呼气末正压通气对腹腔镜肝切除手术患者中心静脉压及术中出血的影响  

Effect of positive end-expiratory pressure ventilation on central venous pressure and intraoperative blood loss in patients undergoing laparoscopic hepatectomy

作　　者：祁涛 沙欢欢 陈静 朱昌茂 潘熊熊 QI Tao;SHA Huan-huan;CHEN Jing;ZHU Chang-mao;PAN Xiong-xiong(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,江苏南京210029

出　　处：《海南医学院学报》2020年第23期1788-1792,共5页Journal of Hainan Medical University

基　　金：江苏省卫计委青年医学重点人才资助项目(QNRC2016586)。

摘　　要：目的:探讨肺保护性通气策略中呼气末正压(PEEP)对腹腔镜肝切除手术患者中心静脉压(CVP)及术中出血的影响。方法:选择接受腹腔镜肝切除手术的患者46例,男性25例,女性21例,ASAⅡ~Ⅲ级,随机分为两组:A组设定潮气量6 mL/kg理想体重(PBW),PEEP 0 cmH2O;B组潮气量设定同A组,PEEP 8 cmH2O。记录插管后平卧位(T0)、气腹后平卧位(T1)、气腹后头高脚底20°体位(反Trendelenberg体位)(T2)、手术结束后平卧位(T3)时的CVP、平均动脉压(MAP)、气道峰压(Ppeak),计算动态肺顺应性(Cdyn);记录术中硝酸甘油使用量、手术出血量。结果:与A组比较,T1、T2时B组CVP明显升高(P<0.05);组内比较,两组T2时CVP明显较T1时下降(P<0.05);T3时B组Cdyn明显高于A组(P<0.05);术中硝酸甘油使用量B组明显高于A组(P<0.05)。两组术中补液量和出血量无明显统计学差异(P>0.05)。结论:在肺保护性通气策略中使用8 cmH2O的PEEP能够改善腹腔镜肝切除手术患者的Cdyn,但增加CVP,需要更多的使用控制性低中心静脉压(controlled low central venous pressure,CLCVP)技术来减少术中出血。Objective To investigate the effects of positive end-expiratory pressure(PEEP)ventilation on central venous pressure(CVP)and intraoperative blood loss in patients undergoing laparoscopic hepatectomy.MethodsA total of 46 patients undergoing laparoscopic hepatectomy including 25 males,21 females,all patients were categorized as ASAⅡ-Ⅲlevel,and were randomly divided into two groups.For group A,the tidal volume was set to 6 mL/kg(Predicted Body Weight,PBW)and PEEP was set to 0 cmH2O.The tidal volume of group B was set at the same level of group A,PEEP was set to 8 cmH2O.CVP,MAP,and Ppeak were recorded in the supine position after intubation(T0),supine position after pneumoperitoneal(T1),anti-trendelenberg position after pneumoperitoneal(T2),supine position after surgery(T3),and Cdyn was calculated.The amount of nitroglycerin and the volume of blood loss were recorded.ResultsCompared with group A,the CVP of group B was significantly increased at T1 and T2(P<0.05).CVP decreased significantly in both groups at T2 comparing with T1(P both<0.05).At T3,Cdyn in group B was significantly higher than that in group A(P<0.05).The amount of nitroglycerin in group B was significantly higher than that in group A(P<0.05).There was no significant difference in intraoperative fluid rehydration and blood loss between the two groups(P>0.05).ConclusionPEEP with 8 cm H2O can improve Cdyn in patients undergoing laparoscopic hepatectomy,but it increases CVP which requires more use of controlled low central venous pressure techniques to reduce intraoperative blood loss.

关 键 词：呼气末正压 腹腔镜手术 肝切除术 中心静脉压 

分 类 号：R657.3[医药卫生—外科学]