肥胖患者接受腹腔镜下袖状胃切除术的肺通气策略  

Ventilation strategy in obese patients undergoing laparoscopic sleeve gastrectomy

作　　者：丁宁静 余琼 DING Ning-jing;YU Qiong(Department of Anesthesiology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院麻醉科,上海200040

出　　处：《中国临床医学》2023年第5期840-845,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(82171188).

摘　　要：目的探讨肥胖患者在腹腔镜下袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)中的理想通气策略。方法回顾性收集2012年1月1日至2017年1月31日在复旦大学附属华山医院接受LSG的肥胖患者在DoCare系统中的数据。根据相对于理想体质量(ideal body weight,IBW)的术中平均潮气量(tidal volume,V_(T))将患者分为3组:低V_(T)组(平均V_(T)<10 mL/kg IBW)、中等V_(T)组(平均V_(T) 10~12 mL/kg IBW)和高V_(T)组(平均V_(T)>12 mL/kg IBW)。比较3组患者基线资料,术中气腹期间的气道峰压(peak airway pressure,Ppeak)、呼气末正压(positive end-expiratory pressure,PEEP)、氧合指数(oxygenation index,OI)、肺动态顺应性(dynamic compliance,Cdyn),以及术后呼吸系统并发症。结果共纳入81例患者,其中97.5%(79/81)采用压力控制通气模式,64.2%(52/81)术中平均V_(T)≥10 mL/kg IBW。3组患者气腹期间通气参数比较显示,与低V_(T)组相比,中等V_(T)组和高V_(T)组Cdyn显著增加(P<0.01);高V_(T)组的Ppeak和OI显著增加(P<0.01)。3组患者PEEP、拔管时间和术后肺部并发症差异无统计学意义。结论与V_(T)<10 mL/kg IBW和V_(T)>12 mL/kg IBW相比,肥胖患者LSG术中接受V_(T) 10~12 mL/kg IBW时的肺顺应性较好,且气道压力没有显著增加,可以作为此类手术的通气策略选择。Objective To explore the ideal ventilation strategy for obese patients undergoing laparoscopic sleeve gastrectomy(LSG).Methods Data of obese patients undergoing LSG from January 1,2012 to January 31,2017 in Huashan Hospital,Fudan University were retrospectively collected from the hospital DoCare system.According to the mean tidal volume(V_(T))relative to the ideal body weight(IBW),the patients were divided into three groups:low V_(T) group(average V_(T)<10 mL/kg IBW),medium V_(T) group(average V_(T) 10-12 mL/kg IBW)and high V_(T) group(average V_(T)>12 mL/kg IBW).The general data,peak airway pressure(Ppeak),positive end-expiratory pressure(PEEP),oxygenation index(OI),pulmonary dynamic compliance(Cdyn)during pneumoperitoneum and postoperative respiratory complications were compared among the three groups.Results A total of 81 patients were included,of which 97.5%(79/81)patients were ventilated with pressure-controlled ventilation(PCV)mode and 64.2%(52/81)patients received V_(T)≥10 mL/kg IBW during pneumoperitoneum.Compared with the low V_(T) group,the Cdyn in the middle V_(T) group and the high V_(T) group increased significantly,and the Ppeak and OI in the high V_(T) group increased significantly(P<0.01).There was no significant difference in PEEP,extubation time and postoperative pulmonary complications among the three groups.Conclusions Compared with V_(T)<10 mL/kg IBW and V_(T)>12 mL/kg IBW,obese patients receiving LSG with V_(T) 10-12 mL/kg IBW had better lung compliance and no significant increase in airway pressure,which could be used as a ventilation strategy for this kind of surgery.

关 键 词：肥胖 潮气量 肺顺应性 气道峰压 氧合指数 腹腔镜下袖状胃切除术 

分 类 号：R614.2[医药卫生—麻醉学]