反比通气对病态肥胖患者腹腔镜袖状胃减容术呼吸力学和术后肺部并发症的影响  

Effect of Inverse Ratio Ventilation on Respiratory Mechanics and Postoperative Pulmonary Complications in Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy

作　　者：朱丽萍 王凡 张传武 唐旺 王光磊 ZHU Liping;WANG Fan;ZHANG Chuanwu(Department of Anesthesiology,The Affiliated Hospital of Xuzhou Medical University,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院麻醉科,221000

出　　处：《医学研究杂志》2024年第1期165-169,共5页Journal of Medical Research

摘　　要：目的研究反比通气对病态肥胖患者腹腔镜袖状胃减容术呼吸力学和肺部并发症(postoperative pulmonary complications,PPCs)的影响。方法选择62例病态肥胖计划行袖状胃减容术的患者,患者年龄18~65岁,BMI≥35kg/m 2且合并糖尿病、高血压、高脂血症等代谢性疾病或BMI≥40kg/m 2,ASA分级Ⅱ~Ⅲ级,随机分为对照组(PVG组)和反比组(IRV组),两组均采用压力控制容量保证通气模式(PCV-VG),调节通气压力以维持潮气量(tide volume,VT)7~8ml/kg,呼吸频率(respiratory rate,RR)12次/分钟。其中反比组吸呼比(I∶E)设置为2∶1,对照组I∶E为1∶2,记录气管插管后5min(T 1)、气腹后15min(T 2)、30min(T 3)、60min(T 4)、手术结束(T 5)时的呼吸力学指标包括动态肺顺应性(dynamic lung compliance,Cdyn)、气道峰压(peak airway pressure,Ppeak)、平台压(plateau pressure,Pplat)和平均气道压(mean airway pressure,Pmean)等,抽取麻醉前(T 0)、T 1~T 5动脉血进行血气分析,计算无效腔率(dead space fraction,VD/VT),记录术中血流动力学参数、术后第1、2天肺部并发症的发生情况以及7天内累积发生率。结果与对照组比较,反比组T 1~T 5的Cdyn、Pmean、呼气末正压(positive end expiratory pressure,PEEP)、氧分压(PaO 2)明显升高(P>0.05);T 2~T 5的Ppeak、Pplat、T 3~T 5的VD/VT明显降低(P<0.05)。两组术后均发生肺部并发症,且为1级并发症,但差异无统计学意义。结论在接受腹腔镜袖状胃减容术的病态肥胖患者中,反比通气有效改善了呼吸力学和氧合。Objective To observe the effects of inverse ratio ventilation on respiratory mechanics and postoperative pulmonary complications in morbidly obese patients during laparoscopic sleeve gastrectomy Methods A total of 62 morbidly obese patients for a laparoscopic sleeve gastrectomy were scheduled(18-65 years old,BMI≥35kg/m 2 in combination with diabetes,hypertension,hyperlipemia,and other metabolic diseases,or BMI≥40kg/m 2,ASAⅡorⅢ).Patients were randomly assigned to two groups:inverse ratio ventilation group(IRV)and control group(PVG).Two groups were adjusted with an actual tidal volume(VT)of 7-8ml/kg,and respiratory rates of 12 breaths/min.In the IRV group,the ratio of I∶E was 2∶1;in the control group,the ratio of I∶E was 1∶2.We recorded the indexes of respiratory mechanics and the blood gas at the baseline(T 0),5min after anesthesia(T 1),15min after pneumoperitoneum(T 2),30min after pneumoperitoneum(T 3),60min after pneumoperitoneum(T 4)and the end of surgery(T 5),and the occurrence of pulmonary complications on day 1,day 2 after operation was observed,and the cumulative incidence of PPCs at 7 days was counted.Results Compared to the control group,the dynamic lung compliance(Cdyn),mean airway pressure(Pmean),positive end expiratory pressure(PEEP),and the PaO 2 at T 1-T 5 of the inverse ventilation group were increased significantly(P<0.05),the Ppeak、Pplat at T 2-T 5 and dynamic lung compliance(VD/VT)at T 3-T 5 were decreased significantly(P<0.05),and no difference in the PaCO 2 and P ET CO 2 in the two groups.Grade 1 pulmonary complications occurred in both groups,and there was no difference in the total occurrence of pulmonary complications at 7 days.Conclusion Inverse ventilation effectively may improve respiratory mechanics and oxygenation in morbidly obese patients undergoing laparoscopic sleeve gastrectomy.

关 键 词：反比通气 病态肥胖 呼吸力学 袖状胃减容术 肺部并发症 

分 类 号：R164.2[医药卫生—公共卫生与预防医学]