不同通气模式对腹腔镜肝切除术患者出血量和术后肝功能的影响  

Effects of different ventilation mode types on intra-operative blood loss and postoperative liver function in patients undergoing laparoscopic hepatectomy

作　　者：张华明 杨佳[1] 章敏[1] 韩明明 马骏[1] 李启健 谢言虎 ZHANG Huaming;YANG Jia;ZHANG Min;HAN Mingming;MA Jun;LI Qijian;XIE Yanhu(Department of Anesthesiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2023年第1期8-12,共5页Journal of Clinical Anesthesiology

基　　金：中国博士后科学基金资助项目(2019M662179)。

摘　　要：目的探讨不同通气模式对腹腔镜肝切除术患者出血量和术后肝功能的影响。方法选择择期全麻下行腹腔镜肝切除术患者60例,男35例,女25例,年龄18~64岁,BMI 18.5~24.0 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:压力控制通气(PCV)组和容量控制通气(VCV)组,每组30例。PCV组通过调整气道峰压,使术中V T达到理想体重×8 ml,同时调整RR维持P ET CO_(2)35~45 mmHg;V组V T设定为理想体重×8 ml,同时调整RR维持P ET CO_(2)35~45 mmHg。记录麻醉诱导后10 min(T_(0))、气腹后10 min(T_(1))、切肝前10 min(T_(2))、切肝后10 min(T_(3))、气腹结束后10 min(T_(4))吸气峰压(Ppeak)、气道平均压(Pmean)、CVP、PaCO_(2)和氧合指数(PaO_(2)/FiO_(2))。记录术中胶体液用量和出血量,术后24、48和72 h丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)以及腹腔引流量。结果与T_(0)时比较,T_(1)—T_(3)时两组Ppeak均明显升高(P<0.05);T_(1)—T_(4)时VCV组、T_(3)和T_(4)时PCV组CVP均明显升高(P<0.05)。与VCV组比较,PCV组T_(1)、T_(2)时CVP明显降低(P<0.05),术中胶体液用量和出血量明显减少(P<0.05)。两组术后24、48和72 h的ALT、AST和腹腔引流量差异无统计学意义。结论压力控制通气模式下腹腔镜肝切除术中患者出血量明显减少,可能与术中较低的气道峰压有关,但两种不同通气模式下患者术后肝功能损伤无明显差异。Objective To investigate the effects of different types of ventilation mode on intra-operative blood loss and postoperative liver function in patients undergoing laparoscopic hepatectomy.Methods Sixty patients,35 males and 25 females,aged 18-64 years,BMI 18.5-24.0 kg/m^(2),ASA physical statusⅡorⅢ,who underwent laparoscopic hepatectomy were randomly allocated to receive pressure-controlled ventilation(group PCV,n=30)and volume-controlled ventilation(group VCV,n=30)during general anesthesia.Group PCV:the tidal volume was set through adjusting the peak airway pressure,so that the tidal volume of patients during operation was the ideal weight×8 ml,and the respiratory rate was adjusted to maintain P ET CO_(2) between 35 and 45 mmHg.Group VCV:the ideal weight×8 ml was used to set the tidal volume of patients during operation,regardless of the airway pressure,and the respiratory rate was adjusted to maintain P ET CO_(2) between 35 and 45 mmHg.The peak inspiratory pressure(Ppeak),mean airway pressure(Pmean),CVP,partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2))were measured for each patient 10 minutes after anesthesia induction(T_(0)),10 minutes after pneumoperitoneum(T_(1)),10 minutes before hepatectomy(T_(2)),10 minutes after hepatectomy(T_(3)),and 10 minutes after pneumoperitoneum(T_(4)).The intraoperative blood loss,transfusion volume,and urine volume during the operation were recorded.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),and abdominal drainage volume were also monitored and recorded 24,48,and 72 hours after surgery.Results Compared with T_(0),Ppeak of both groups was significantly increased at T_(1)-T_(3)(P<0.05),CVP in group VCV was significantly increased at T_(1)-T_(4),and in group PCV at T_(3) and T_(4)(P<0.05).Compared with group VCV,CVP in group PCV was significantly decreased at T_(1) and T_(2)(P<0.05),the amount of colloid and blood loss in group PCV were significantly decreased(P<0.05).The two groups showed no significant differences in ALT,AST lev

关 键 词：腹腔镜肝切除术 压力控制通气 容量控制通气 吸气峰压 氧合指数 

分 类 号：R735.7[医药卫生—肿瘤]