不同水平呼气末正压对腹腔镜下肝部分切除术患者中心静脉压的影响  

The effect of different levels of positive end expiratory pressure on central venous pressure in patients undergoing laparoscopic partial hepatectomy

作　　者：赵惠娟 蔡玉婷 张文清 ZHAO Hui-Juan;CAI Yu-Ting;ZHANG Wen-Qing(Department of Anesthesiology,Zhangzhou Hospital Affiliated to Fujian Medical University,Zhangzhou 363000,Fujian,China)

机构地区：[1]福建医科大学附属漳州市医院麻醉科,福建漳州363000

出　　处：《吉林医学》2025年第1期50-53,共4页Jilin Medical Journal

摘　　要：目的:探讨不同水平呼气末正压(PEEP)对行腹腔镜下肝部分切除术患者中心静脉压(CVP)的影响。方法:选取福建医科大学附属漳州市医院2021年11月~2022年11月收治的行腹腔镜下肝部分切除术患者81例作为研究对象,根据术中使用不同的PEE P值进行分组:A组(n=27)实施小潮气量6 ml/kg理想体重(PBW),PEEP 0 cmH_(2)O的通气模式;B组(n=27)实施小潮气量6 ml/kg PBW,PEEP 0 cmH_(2)O的通气模式;C组(n=27)实施小潮气量6 ml/kg PBW,PEEP 8 cmH_(2)O的通气模式。分别记录并比较三组不同体位时间点[插管后平卧位(T0)、气腹后平卧位(T1)、气腹后反特伦德伦伯体位(T2)、手术结束后平卧位(T3)]的CVP、平均动脉压(MAP)以及气道峰压;比较三组术中出血量、红细胞输注量与血浆输注量;观察并比较三组围术期的不良反应发生情况。结果:三组T0、T3之间的CVP比较差异无统计学意义(P>0.05),T1、T2时,A组的CVP低于B组、B组低于C组,三组间比较,差异有统计学意义(P<0.05);三组在T0、T1、T2、T3时的MAP比较差异无统计学意义(P>0.05),A组在T0、T1、T2时的气道峰压低于B组,B组低于C组,三组间比较,差异有统计学意义(P<0.05);T3时的气道峰压比较差异无统计学意义(P>0.05);三组术中出血量、红细胞输注量与血浆输注量比较,差异无统计学意义(P>0.05);B组的不良反应发生率低于A组、C组,差异有统计学意义(P<0.05)。结论:在腹腔镜下肝部分切除术中实施PEEP 4 cmH_(2)O的通气模式,功效更为积极,能够一定程度上稳定患者术中的CVP,有利于降低或防止不良反应的发生。Objective To explore the impact of different levels of positive end expiratory pressure(PEEP)on central venous pressure(CVP)in patients undergoing laparoscopic partial hepatectomy.Method 81 patients who underwent laparoscopic partial hepatectomy admitted to our hospital from November 2021 to November 2022 were selected as the research subjects.They were divided into groups based on different PEEP values used during the surgery:Group A(27 cases)implemented a ventilation mode of low tidal volume 6 ml/kg PBW,PEEP 0 cmH_(2)O;Group B(27 cases)implemented a ventilation mode of low tidal volume 6 ml/kg PBW,PEEP 0 cmH_(2)O;Group C(27 cases)implemented a ventilation mode of low tidal volume 6 ml/kg PBW,PEEP 8 cmH_(2)O.Record and compare the CVP,mean arterial pressure(MAP),and peak airway pressure of three different body positions at different time points:supine position after intubation(T0),supine position after pneumoperitoneum(T1),reverse Trendelenburg position after pneumoperitoneum(T2),and supine position after surgery(T3);Compare the intraoperative bleeding volume,red blood cell infusion volume,and plasma infusion volume among the three groups;Observe and compare the incidence of adverse reactions during the perioperative period among the three groups.Results There was no significant difference in CVP between the three groups of T0 and T3(P>0.05).At T1 and T2,the CVP of Group A was lower than that of Group B,and Group B was lower than that of Group C.The difference between the three groups was statistically significant(P<0.05);There was no significant difference in MAP among the three groups at T0,T1,T2,and T3(P>0.05).Group A had lower peak airway pressure at T0,T1,and T2 than Group B,while Group B had lower peak airway pressure than Group C.The difference between the three groups was statistically significant(P<0.05),and there was no significant difference in peak airway pressure at T3(P>0.05);There was no significant difference in intraoperative bleeding volume,red blood cell infusion volume,and plasma infusion vol

关 键 词：不同水平呼气末正压 腹腔镜下肝部分切除术 中心静脉压 平均动脉压 气道峰压 

分 类 号：R657.3[医药卫生—外科学]