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| 呼气末正压通气对腹腔热灌注化疗患者呼吸力学及肺功能的影响 |
| Effect of positive end-expiratory pressure on respiratory mechanics and pulmonary function in patients receiving continuous hyperthermic peritoneal perfusion |
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| DOI： |
| 中文关键词: 呼气末正压 机械通气 热灌注化疗 肺功能 呼吸力学 |
| 英文关键词: Positive end-expiratory pressure Mechanical ventilation Hyperthermic peritoneal perfusion Pulmonary function Respiratory mechanics |
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| 中文摘要: |
| 目的 探讨不同呼气末正压通气对腹腔热灌注化疗患者呼吸力学及肺功能的影响。方法 选择择期行腹膜癌热灌注化疗的患者90例,男55例,女35例,年龄40～70岁,ASA Ⅰ～Ⅲ级。随机分为三组,每组30例。A组为容量控制通气(VCV)组,VT 10 ml／kg;B组为VCV+低PEEP组,VT 6 ml／kg,PEEP 5cm H2O;C组为VCV+高PEEP组,VT 6 ml／kg,PEEP 10cm H2O;术中调整RR维持PETCO2 35～45 mm Hg。于气管插管后5 min(T1)、腹腔热灌注化疗开始前(T2)、化疗结束时(T3)、气管拔管前(T4)记录气道峰压(Ppeak)、气道平台压(Pplat)和平均气道压(Pmean),计算动态肺顺应性(Cdyn)。并取桡动脉血进行血气分析,计算氧合指数(OI)、呼吸指数(RI)、肺泡 动脉血氧分压差(A-aDO2)及死腔率(VD／VT)。记录术后7 d内肺部相关并发症情况。结果 与A组比较,T1～T4时B、C组Ppeak、Pplat、A-aDO2和RI明显降低,OI和VD／VT 明显升高(P<0.05);T2～T4时B、C组Pmean明显降低,Cdyn和PaO2明显升高(P<0.05)。与T1比较,T2～T4时A组Ppeak、Pplat和Pmean明显升高,Cdyn明显降低(P<0.05);T3时B组Ppeak和Pplat明显升高(P<0.05),T2～T4 Pmean明显升高(P<0.05),T3、T4时Cdyn明显降低(P<0.05);T2～T4时C组Ppeak、Pplat和Pmean明显升高(P<0.05),T3、T4时Cdyn明显降低(P<0.05)。与T0时比较,T2～T4时三组PaO2和OI明显降低,A-aDO2、RI和VD/VT明显升高(P<0.05)。术后7 d内B、C组肺部感染、低氧血症和肺不张的发生率明显低于A组(P<0.05)。结论 小潮气量(6 ml／kg)联合PEEP(5 cm H2O)通气可以显著改善腹膜癌患者术中热灌注期间肺功能,降低围术期肺部并发症的发生风险。 |
| 英文摘要: |
| Objective To explore the effects of positive end expiratory pressure on intraoperative pulmonary function and respiratory mechanics in patients receiving continuous hyperthermic peritoneal perfusion. Methods Ninety patients (55 males, 35 females, aged 40-70 years, ASA grade Ⅰ-Ⅲ) undergoing continuous hyperthermic peritoneal perfusion were selected and divided into 3 groups (n=30 each): regular volume controlled ventilation group (group A), 5 cm H2O PEEP group (group B) and 10 cm H2O PEEP group (group C). After tracheal intubation, the mechanical ventilation parameters in groups A, B and C were respectively given tidal volume (VT) 10 ml／kg without positive end expiratory pressure (PEEP), VT 6 ml／kg with 5 cm H2O PEEP, and VT 6 ml／kg with 10cm H2O. PETCO2was maintained at 35-45 mm Hg. Arterial blood samples were collected for blood gas analysis 5 min after (T1), before CHPP (T2), the end of CHPP (T3), and before the end of mechanical ventilation (T4). Besides, Pplat, Pmean, Ppeak, PaCO2, PaO2were recorded and Cdyn, OI, RI, A-aDO2 as well as VD／VT were calculated at all time points simultaneously. Pulmonary complications during 7 days after surgery were also recorded. Results Compared with group A, Ppeak, Pplat, A-aDO2 and RI were all significantly lower (P<0.05), while OI and VD／VT were higher in groups B and C at T1-T4 (P<0.05); at T2-T4, Cdyn and PaO2 were higher with lower Pmean in groups B and C (P<0.05). Compared with T1, Ppeak, Pplat and Pmean were higher (P<0.05) while Cdyn was lower (P<0.05) in group A at T2-T4; In Group B, Ppeak and Pplat were higher at T3 (P<0.05), Pmean was higher at T2-T4 (P<0.05) and Cdyn was lower at T3, T4 (P<0.05); in group C, Ppeak, Pplat and Pmean were all higher at T2-T4 (P<0.05), Cdyn was lower at T3, T4 (P<0.05); OI and PaO2were lower (P<0.05), while A-aDO2, VD／VT and RI were all higher (P<0.05) at T2-T4 in the three groups. In addition, the incidence rates of pulmonary infection, hypoxemia, and atelectasis were significantly lower in groups B and C during 7 days after surgery than those of group A (P<0.05). Conclusion PEEP (5 cm H2O) with VT (6 ml／kg) could effectively improve intraoperative pulmonary function and reduce the risk of perioperative pulmonary complications of the patients receiving continuous hyperthermic peritoneal perfusion. |
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