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| 肥胖患者腹腔镜结直肠癌根治术中实时食管压监测下呼气末正压通气对肺通气的影响 |
| Effect of positive end-expiratory pressure ventilation on pulmonary ventilation in obese patients undergoing laparoscopic radiography for colorectal cancer under esophageal pressure |
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| DOI：10.12089/jca.2018.06.012 |
| 中文关键词: 实时食管压监测 肥胖 腹腔镜结肠癌手术 呼气末正压通气 |
| 英文关键词: Real-time esophageal pressure monitoring Obesity Laparoscopic colorectal cancer surgery Positive end-expiratory pressure ventilation |
| 基金项目:云南省医疗卫生单位内设研究机构科研项目基金(2016NS044) |
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| 中文摘要: |
目的 探讨实时食管压监测指导下设定呼气末正压(positive end expiratory pressure, PEEP)通气参数对肥胖腹腔镜结直肠癌根治术患者的临床价值。
方法 选择2016年1—12月收治的拟行腹腔镜结直肠癌根治术的肥胖患者90例, 男50例, 女40例, 年龄40～65岁, BMI>30 kg/m2, ASA Ⅱ或Ⅲ级, 采用随机数字表法将患者随机分为三组: P组、PEEP5组和PEEP10组, 设置VT 8 ml/kg, 分别在肺复张后给予个体化PEEP(采用实时食管压监测通过计算呼气末跨肺压=0 cmH2O和吸气末跨肺压=25 cmH2O确定最佳PEEP)、PEEP 5 cmH2O和10 cmH2O。观察气腹建立前(T0)、气腹建立后10 min(T1)、气腹后头低40.5°足高位20 min(T2)和气腹结束(T3)时的呼吸力学指标。
结果 T1—T3时P组Ppeak、SBP明显低于，PaO2/FiO2明显高于PEEP5组和PEEP10组（P<0.05）；T2时P组Pplat、Raw明显低于PEEP5组（P<0.05）；T2、T3时P组Cst明显高于PEEP5组（P<0.05）；T1、T2时P组DBP明显低于PEEP5组和PEEP10组（P<0.05）。
结论 实时食管压监测应用于PEEP通气的肥胖腹腔镜结肠癌手术患者，能够有效改善患者呼吸和循环功能。 |
| 英文摘要: |
Objective To investigate the clinical value of setting positive end-expiratory pressure parameters under real-time esophageal pressure monitoring for obese laparoscopic radical resection of colorectal cancer.
Methods Ninety obese patients undergoing laparoscopic radical resection of colorectal cancer, 50 males and 40 females, aged 40-65 years, BMI >30 kg/m2, ASA physical status Ⅱ or Ⅲ, were enrolled in our hospital from January to December in 2016. The patients were randomly divided into groups P, PEEP5 and PEEP10, and VT 8 ml/kg were given individually PEEP (PEEP was determined by esophageal pressure monitoring by calculating end-expiratory pressure of lung cessation=0 cmH2O and end-inspiratory suction of lung cessation=25 cmH2O), PEEP 5 cmH2O and PEEP 10 cmH2O. The indexes of breath mechanics were observed before the establishment of pneumoperitoneum (T0), 10 min after the establishment of pneumoperitoneum (T1), 40.5° after pneumoperitoneum for 20 min (T2) and at the end of pneumoperitoneum (T3).
Results Ppeak and SBP were significantly lower, while PaO2/FiO2 was significantly higher in group P than those in groups PEEP5 and PEEP10 at T1-T3 (P < 0.05). Pplat and Raw in group P were significantly lower than that in group PEEP5 at T2 (P < 0.05). Cst in group P was significantly higher than that in group PEEP5 at T2 and T3 (P < 0.05). DBP in group P was significantly lower than that in groups PEEP5 and PEEP10 at T1 and T2 (P < 0.05)
Conclusion Real-time esophageal pressure monitoring can be effective in improving respiratory and circulatory function in obese patients with laparoscopic colon cancer after positive end-expiratory pressure. |
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