经食道超声心动图观察PEEP对妇科腹腔镜手术静脉气栓影响的研究  

Study on Effect of PEEP on Venous Gas Embolus in Gynecological Laparoscopic Operation by Transesophageal Echocardiography

作　　者：李玲 卢慧勤[1] 赖淑梅[1] Li Ling(Shenzhen Baoan District Maternal and Child Health Hospital,Shenzhen Guangdong 518000)

机构地区：[1]深圳市宝安区妇幼保健院,广东深圳518000

出　　处：《黑龙江医药》2023年第3期557-561,共5页Heilongjiang Medicine journal

基　　金：深圳市宝安区科技计划项目(项目编号:2020JD333)。

摘　　要：目的:探讨经食道超声心动图观察呼气终末正压(PEEP)对妇科腹腔镜手术静脉气栓影响。方法:选择2020年7月至2022年11月于我院行妇科腹腔镜手术治疗的120例患者为研究对象,采用随机数字表法将所有患者分为A组、B组与C组,各40例。A组:PEEP=0cmH_(2)O;B组:PEEP=5cmH_(2)O;C组:PEEP=10cmH_(2)O,所有患者均进行统一麻醉处理并规定标准输液量,术中气腹压维持在12~14mmHg。比较三组各时间点呼吸及循环指标水平;比较三组静脉气栓发生率、气栓发生时间和气栓等级,试找出PEEP值对妇科腹腔镜手术发生气体栓塞的影响。结果:三组各时间点SBP、DBP与SPO_(2)水平组内比较均未见明显异常改变(P>0.05);随手术进行,三组HR均持续性降低(P<0.05);T1~T5时间点,三组PETCO_(2)与气道峰值压力均明显升高(P<0.05)。三组各时间点呼吸及循环指标水平组间比较均未见明显差异(P>0.05)。C组未见静脉气栓发生,本组静脉气栓发生率低于A组(P<0.05)。结论:PEEP不同水平的选择对妇科腹腔镜手术患者术中呼吸及循环指标均不会造成明显影响,临床应用的安全性较高;高水平的PEEP可一定程度上降低患者静脉气栓发生风险,值得推广应用。Objective:To investigate the effect of PEEP on venous gas embolus in gynecological laparoscopic operation by transesophageal echocardiography.Methods:A total of 120 patients who underwent gynecological laparoscopic surgery in our hospital from July 2020 to August 2022 were selected as research objects.All patients were divided into group A,group B and group C by random number table method,with 40 cases in each group.Group A:PEEP=0cmH_(2)O;Group B:PEEP=5cmH_(2)O;Group C:PEEP=10cmH_(2)O;all patients underwent unified anesthesia and standard infusion volume;intraoperative pneumoperitoneum pressure was maintained at 12-14mmHg.The levels of respiration and circulation indexes were compared among the three groups at each time point.The incidence of venous gas thrombus was compared among the three groups.Results:There were no significant abnormal changes in SBP,DBP and SPO_(2) levels in three groups at each time point(P>0.05).With the operation,HR in all three groups decreased continuously(P<0.05).From T1 to T5,PETCO_(2) and peak airway pressure were significantly increased in the three groups(P<0.05).There were no significant differences in respiration and circulation indexes among the three groups at each time point(P>0.05).There was no occurrence of venous gas thrombus in group C,and the incidence of venous gas thrombus in group C was lower than that in group A(P<0.05).Conclusions:Different levels of PEEP have no significant effect on the intraoperative respiratory and circulation indexes in gynecological laparoscopic surgery patients,and the clinical application is relatively safe.High level PEEP can reduce the risk of occurrence of venous gas thrombus in patients to a certain extent,and is worth popularizing and applying.

关 键 词：经食道超声心动图 呼气终末正压 妇科腹腔镜手术 静脉气栓 

分 类 号：R713[医药卫生—妇产科学]