实用医学杂志 ›› 2023, Vol. 39 ›› Issue (4): 465-470.doi: 10.3969/j.issn.1006⁃5725.2023.04.014

• 临床研究 • 上一篇    下一篇

压力控制容量保证在Trendelenburg 位机器人辅助腹腔镜手术中的应用价值 

邢瑞1 蒿梦潇2 杨森2 茆烨2 颜明1    

  1. 1 徐州医科大学附属医院麻醉科(江苏徐州 221002);2 徐州医科大学(江苏徐州 221004)

  • 出版日期:2023-02-25 发布日期:2023-02-25
  • 通讯作者: 颜明 E⁃mail:yjy3001@163.com
  • 基金资助:
    江苏省教育厅高校省级重点实验室开放基金资助项目(编号:KJS08004)

Application value of PCV ⁃VG ventilation in long ⁃ time robot ⁃ assisted laparoscopic surgery in Trendelen⁃ burg position

XING Rui*,HAO Mengxiao,YANG Sen,MAO Ye,YAN Ming.   

  1. Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China

  • Online:2023-02-25 Published:2023-02-25
  • Contact: YAN Ming E⁃mail:yjy3001@163.com

摘要:

目的 探究在 Trendelenburg 位长时间机器人辅助腹腔镜手术中应用压力控制容量保证通气 模式对患者呼吸力学和肺功能的影响。方法 选择择期行机器人辅助腹腔镜下腹部手术患者 76 例,随机 分为压力控制容量保证通气组(P 组)和容量控制通气组(V 组)。记录诱导后即刻(T2),气腹后 20 min (T3)、1 h(T4)、2 h(T5)、3 h(T6),放气腹后 10 min(T7)的气道峰压、气道平台压、肺动态顺应性及气道阻力; 记录诱导前(T1)、T2 - T7、拔管后 20 min(T8)的氧合指数及肺内分流率;记录术后肺部并发症发生率,并用 超声评估 T1、T8及术后第 1、3 天的肺不张情况。结果 呼吸力学:与 T2相比,两组气腹期间(T3 - T6)的气 道峰压、平台压、气道阻力及肺动态顺应性变化差异均有统计学意义(P < 0.05);与 V 组相比,P T3 - T7 的气道峰压和平台压,T3 - T6的气道阻力均显著降低(P < 0.05),肺顺应性除 T2、T3外均显著增高(P < 0.05)。肺功能:与 T1相比,两组 T2 - T7氧合指数和肺内分流率变化差异有统计学意义(P < 0.05);与 V 相比,P T4 - T6的肺内分流率显著降低、T5 - T6的氧合指数显著升高(P < 0.05)。两组术后并发症发生率 差异无统计学意义(P > 0.05);术后 P 组肺不张程度较 V 组显著降低(P < 0.05)。结论 与容量控制通气 相比,压力控制容量保证通气可降低气道峰压、平台压和气道阻力,提高肺顺应性,改善氧合和肺内分流, 减少术后肺不张,应用于长时间Trendelenburg 位机器人辅助腹腔镜手术具有一定优势。

关键词:

压力控制容量保护, 机器人辅助手术, 长时间气腹, 肺功能

Abstract:

Objective To investigate the effects of applying pressure ⁃controlled and volume ⁃guaranteed ventilation mode during prolonged robotic⁃assisted laparoscopic surgery in the Trendelenburg position on patients′ respiratory mechanics and pulmonary function. Methods Seventy ⁃six patients undergoing elective robot ⁃assisted laparoscopic lower abdominal surgery were selected and randomly divided into pressure⁃controlled volume⁃guaran⁃ teed ventilation group(group P)and volume ⁃controlled ventilation group(group V). The peak airway pressure, airway plateau pressure,dynamic lung compliance and airway resistance were recorded immediately after induction (T2),20 min(T3),1 h(T4),2 h(T5)and 3 h(T6)after pneumoperitoneum,and 10 min after extubation(T7); the oxygenation index and intrapulmonary shunt rate were recorded before induction(T1),T2⁃T7,and 20 min after extubation(T8);the postoperative pulmonary complication rate,and pulmonary atelectasis was assessed by ultra⁃ sound at T1,T8,and on postoperative days 1 and 3. Results Respiratory mechanics:compared with T2,the differences in peak airway pressure,plateau pressure,airway resistance and dynamic lung compliance during pneumoperitoneum(T3⁃T6)in both groups were statistically significant(< 0.05);compared with group V,peak airway pressure and plateau pressure in T3 ⁃ T7 and airway resistance in T3 ⁃ T6 in group P were significantly lower (< 0.05),and lung compliance was significantly higher except for T2 and T3(< 0.05). Lung function:com⁃ pared with T1,there were significant differences in the changes of oxygenation index and intrapulmonary shunt rate from T2 to T7 in both groups(< 0.05);compared with group V,the intrapulmonary shunt rate from T4 to T6 and oxygenation index from T5 to T6 in group P were significantly lower(< 0.05). There was no significant difference in the incidence of postoperative complications between the two groups(> 0.05);the degree of postoperative pul⁃monary atelectasis was significantly lower in group P compared with group V(< 0.05). Conclusion Compared with volume⁃controlled ventilation,pressure⁃controlled and volume⁃guaranteed ventilation could reduce peak airway pressure,plateau pressure and airway resistance,improve lung compliance,oxygenation and intrapulmonary shunt,and reduce postoperative pulmonary atelectasis,and has advantages when applied to prolonged Trendelen⁃ burg position robotic⁃assisted laparoscopic surgery.

Key words:

pressure?controlled volume protection, robot?assisted surgery, prolonged pneumoperitone? um, pulmonary function