文章摘要
等比通气对腹腔镜子宫切除术中喉罩通气的影响
Effect of equal ratio ventilation on laryngeal mask ventilation during laparoscopic hysterectomy
  
DOI：10.12089/jca.2020.01.005
中文关键词: 等比通气  喉罩  腹腔镜子宫切除术
英文关键词: Equal ratio ventilation  Laryngeal mask  Laparoscopic hysterectomy
基金项目:河南省科技厅科技攻关项目(182102310253)
作者单位E-mail
张超凡 450001,郑州市,郑州大学第一附属医院麻醉科  
田丹丹 450001,郑州市,郑州大学第一附属医院麻醉科  
刘洋 450001,郑州市,郑州大学第一附属医院麻醉科  
张禄凤 450001,郑州市,郑州大学第一附属医院麻醉科  
史心宇 450001,郑州市,郑州大学第一附属医院麻醉科  
王洁 450001,郑州市,郑州大学第一附属医院麻醉科  
艾艳秋 450001,郑州市,郑州大学第一附属医院麻醉科 aiyanqiu82@163.com 
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中文摘要:
      
目的 观察腹腔镜子宫切除术中使用等比通气(equal ratio ventilation,ERV) 模式对患者呼吸力学、血流动力学和喉罩通气的影响。
方法 择期行腹腔镜子宫切除术女性患者80例,年龄29～63岁,BMI 20～30 kg/m2,ASA Ⅰ或Ⅱ级。按随机数字表法分为ERV组(E组)和常规通气(conventional ratio ventilation, CRV)组(C组),每组40例。常规静脉麻醉诱导后置入喉罩行机械通气,E组I∶E 1∶1;C组I∶E 1∶2。如果术中气道压力峰值(Ppeak)超过35 cmH2O或者喉罩发生严重漏气(不能达到设置VT的80％),则将喉罩更换为气管插管。在麻醉诱导后10 min(T0)、气腹后30 min(T1)、气腹后60 min(T2)、关闭气腹后10 min(T3)时记录Ppeak、气道平台压力(Pplat)、气道平均压力(Pmean)、PETCO2和分钟通气量(MV)等呼吸力学指标;记录酸碱度(pH)、中心静脉氧分压(PcvO2)、中心静脉二氧化碳分压(PcvCO2)等中心静脉血气分析指标;记录HR、MAP、心输出量(CO)、心脏指数(CI)、每搏量(SV)、每搏量变异 (SVV)等血流动力学指标。记录反流误吸、咽喉痛、喉罩带血、更换气管插管等气道并发症的发生情况。
结果 T1—T2时E组Ppeak、Pflat明显低于C组(P<0.05),Pmean明显高于C组(P<0.05)。不同时点两组PcvO2、CO差异无统计学意义。两组均无一例反流误吸。两组咽喉痛、喉罩带血发生率差异无统计学意义。E组更换气管导管发生率明显低于C组(P<0.05)。
结论 在腹腔镜子宫切除术中使用ERV对CO无明显影响并可降低Ppeak,减少喉罩漏气的发生;但在改善患者PcvO2方面未见明显效果。
英文摘要:
      
Objective To observe the effects of equal ratio ventilation (ERV) on laryngeal mask ventilation and respiratory mechanics and hemodynamics during laparoscopic hysterectomy.
Methods Eighty female patients, with a aged 29-63 years, BMI 20-30 kg/m2, falling into ASA physical status Ⅰ or Ⅱ category, scheduled for elective laparoscopic hysterectomy were randomly divided into the ERV group (group E) and the conventional ratio ventilation (CRV) group (group C) according to the method of random number table, 40 cases of each group. After general anesthesia induction, implantation of laryngeal mask as well as mechanical ventilation were performed. After pneumoperitoneum, the I∶E ratio of the group E was 1∶1, and the group C was 1∶2. If the intraoperative peak airway pressure (Ppeak) exceeded 35 cmH2O or the throat mask was severely leaking (not 80％ of the set VT), the mask was replaced with an endotracheal tube. At 10 min (T0) after induction of anesthesia, 30 min (T1) after pneumoperitoneum, 60 min (T2) after pneumoperitoneum, and 10 min (T3) after pneumoperitoneum was closed,the following indicators were recorded: respiratory indicators including Ppeak, platform airway pressure (Pplat), mean airway pressure (Pmean), Minute ventilation (MV)and end-tidal carbon dioxide partial pressure (PETCO2); central venous blood gas analysis such as pH, oxygen partial pressure (PcvO2), and carbon dioxide partial pressure (PcvCO2); hemodynamic indicators including HR, MAP, cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume variation (SVV); airway complications such as reflux aspiration, sore throat, laryngeal mask with blood, replacement of trachea intubation were recorded.
Results At T1 and T2, the Ppeak and Pflat of group E was significantly lower than that of group C (P<0.05), the Pmean of group E was significantly higher than that of group C (P<0.05). There was no significant difference in PcvO2 and CO between the two groups. There was no case of reflux aspiration in both groups. There was no significant difference in the incidence of throat pain and laryngeal mask bleeding between the two groups. The incidence of tracheal intubation replacement in group E was significantly lower than that in group C (P<0.05).
Conclusion During laparoscopic hysterectomy, ERV not only had no significant effect on CO, but also reduced Ppeak and laryngeal mask leakage. Nevertheless, our results did not support ERV use solely for improving PcvO2.
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