小潮气量联合低呼气末正压通气对腹腔镜肝部分切除术病人出血量及术后应激反应的影响  

Effects of low tidal volume combined with low positive end-expiratory pressure ventilation on blood loss and stress response in patients undergoing laparoscopic partial hepatectomy

作　　者：翟荣华[1] 佘勇军 邢春花[1] ZHAI Ronghua;SHE Yongjun;XING Chunhua(Department of Anesthesiology,Nantong Third Hospital Affiliated to Nantong University,Nantong 226000,China)

机构地区：[1]南通大学附属南通第三医院麻醉科,江苏南通226000

出　　处：《临床外科杂志》2021年第12期1192-1195,共4页Journal of Clinical Surgery

基　　金：江苏省卫生健康委2019年度医学科研立项项目(H2019131)。

摘　　要：目的探讨小潮气量联合低呼气末正压通气(PEEP)对腹腔镜下肝部分切除术病人术中出血量的影响,并评估该通气策略对病人应激反应的影响。方法择期行腹腔镜肝部分切除术的肝癌病人120例。将120例病人随机分为试验组和对照组,每组各60例。试验组机械通气方式设置为小潮气量联合低PEEP;对照组采用常规容量控制通气。记录病人术中出血量、红细胞输注人数、红细胞输注量等血液制品输注情况。记录住院期间肺不张、肺部感染等呼吸系统不良反应发生情况。于手术前1天(T0)、手术结束即刻(T1)、术后3天(T3)、术后7天(T7)抽取外周静脉血,检测上述各时点C反应蛋白(C-reactive protein,CRP)和皮质醇(cortisol,Cor)水平。结果试验组病人术中出血量低于对照组,两组比较,差异有统计学意义(P<0.05)。试验组红细胞输注量、红细胞输注人数均低于对照组,两组比较,差异有统计学意义(P<0.05)。试验组T1、T3时点CRP水平低于对照组,两组比较,差异有统计学意义(P<0.05)。试验组T1时点Cor水平低于对照组,两组比较,差异有统计学意义(P<0.05)。两组病人在院期间术后再次插管、低氧血症、肺部感染、肺不张发生率比较差异均无统计学意义(P>0.05)。结论小潮气量联合低PEEP有助于减少腹腔镜下肝切除术病人术中出血量,并抑制机体围术期应激反应。Objective To evaluate the effects of low tidal volume combined with low PEEP on blood loss and stress response in patients undergoing laparoscopic partial hepatectomy.Methods 120 liver cancer patients,aged 18 to 70 years,undergoing laparoscopic partial hepatectomy were taken part in this study.The patients were randomly divided low tidal volume combined with low PEEP group(Group T)and volume controlled ventilation group(Group C).The included patients were randomly divided into experimental group and control group,with 60 cases in each group.The mechanical ventilation mode of the experimental group was set as low tidal volume combined with low PEEP;The control group was set volume controlled ventilation.The intraoperative blood loss,the number of red blood cell transfusions,red blood cell transfusions and other blood product transfusions of patients were recorded.The incidence of respiratory adverse reactions such as atelectasis and pulmonary infection during hospital stay was recorded.Peripheral venous blood was extracted 1 day before surgery(T0),immediately after surgery(T1),3 days after surgery(T3),and 7 days after surgery(T7).The levels of C-reactive protein(CRP)and COR were measured at the above points.Results The amount of intraoperative blood loss in experimental group was significantly lower than that in control group,the difference was statistically significant(P<0.05).The amount of red blood cell infusion and the number of red blood cell infusion in experimental group were significantly lower than those in control group,with statistical significance(P<0.05).The CRP level at T1 and T3 in experimental group was significantly lower than that in control group,with statistical significance(P<0.05).The level of COR at T1 in experimental group was significantly lower than that in control group,with statistical significance(P<0.05).There were no significant differences in the incidence of postoperative re-intubation,hypoxemia,pulmonary infection and atelectasis between the two groups(P>0.05).Conclusion Low tidal

关 键 词：小潮气量 呼气末正压通气 腹腔镜下肝部分切除术 出血量 应激反应 

分 类 号：R735.7[医药卫生—肿瘤]