通气模式对肥胖患者腹腔镜减重手术后肺部并发症的影响分析  

Impact analysis of ventilation mode on pulmonary complications after laparoscopic weight loss surgery for patients with obese

作　　者：叶茜琳 胡浩翔 许锦雄 涂泽华 卢增停[1] YE Qianlin;HU Haoxiang;XU Jinxiong;TU Zehua;LU Zengting(Department of Anesthesiology,Xiaolan People’s Hospital of Zhongshan,Zhongshan,Guangdong 528415,P.R.China)

机构地区：[1]中山市小榄人民医院麻醉科,广东中山528415

出　　处：《中国普外基础与临床杂志》2024年第8期976-980,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探究不同通气模式对肥胖患者腹腔镜减重手术后肺部并发症(pulmonary complications,PCs)的影响。方法 回顾性收集2019年1月至2023年6月期间于中山市小榄人民医院行腹腔镜减重手术治疗的肥胖患者。根据麻醉期间采用的不同通气模式将患者分为压力控制-容量保证通气(pressure-controlled ventilation-volume guaranteed,PCV-VG)组和容量控制通气(volume-controlled ventilation,VCV)组2组,比较PCV-VG组和VCV组患者的临床病理资料和术后PCs的发生情况,同时采用多因素logistic回归分析影响肥胖患者腹腔镜减重手术后PCs发生的危险因素。结果 本研究共纳入了294例接受腹腔镜减重术治疗的肥胖患者,男138例,女156例;身体质量指数30~55 kg/m^(2)、(42.40±4.87)kg/m^(2),术后发生PCs 63例(21.4%)。PCV-VG组160、VCV组134例,PCV-VG组的麻醉时间、(气管插管后5 min时的)潮气量、(气管插管后5 min、气腹后60 min及手术结束时的)峰值吸气压力和驱动压,以及术后PCs发生率均少或低于VCV组(P<0.05)。将单因素分析有统计学意义的指标及有临床意义的指标如吸烟史、美国麻醉师协会分级、高血压、身体质量指数、手术时间、术前第1秒用力呼气量(forced expiratory volume in 1 second,FEV1)、FEV1/用力肺活量、术中通气模式等纳入进行多因素logistic回归分析。纳入因素经共线性检验分析显示不存在共线性(容差均>0.1,且方差膨胀因子<10),多因素logistic回归分析结果显示,身体质量指数高及术中采用VCV模式增加腹腔镜减重手术后患者PCs发生的概率(P<0.05)。结论 本研究结果提示,对于行腹腔镜减重手术的肥胖患者,通气模式的选择与PCs的发生风险关系密切,在临床工作中,对于肥胖程度高的患者尤其需要关注其术后PCs发生的风险。Objective To explore the effect of different ventilation modes on pulmonary complications(PCs)after laparoscopic weight loss surgery in obese patients.Methods The obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected,then were assigned into pressure-controlled ventilation-volume guaranteed(PCV-VG)group and volume controlled ventilation(VCV)group according to the different ventilation modes during anesthesia.The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared.The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis.Results A total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled,with 138 males and 156 females;Body mass index(BMI)was 30–55 kg/m^(2),(42.40±4.87)kg/m^(2).The postoperative PCs occurred in 63 cases(21.4%).There were 160 cases in the PCV-VG group and 134 cases in the VCV group.The anesthesia time,tidal volume at 5 min after tracheal intubation,peak inspiratory pressure and driving pressure at 5 min after tracheal intubation,60 min after establishing pneumoperitoneum,and the end of surgery,as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group(P<0.05).The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model,such as the smoking history,American Society of Anesthesiologists classification,hypertension,BMI,operation time,forced expiratory volume in 1 second(FEV1),FEV1/forced vital capacity,and intraoperative ventilation mode.It was found that the factors had no collinearity(tolerance>0.1,and variance inflation factor<10).The results of the multivariate logistic regr

关 键 词：压力控制-容量保证通气 容量控制通气 腹腔镜减重手术 肥胖 术后肺部并发症 

分 类 号：R656.61[医药卫生—外科学]