文章摘要
不同水平呼气末正压通气对肥胖患者围术期呼吸功能的影响
Effect of different levels of positive end expiratory pressure on perioperative atelectasis in the obese
  
DOI：10.12089/jca.2021.03.005
中文关键词: 呼气末正压  肺不张  胃减容手术  肥胖
英文关键词: Positive end expiratory pressure  Atelectasis  Bariatric surgery  Obesity
基金项目:
作者单位E-mail
代元大 350005,福州市,福建医科大学附属第一医院麻醉科  
洪秀云 350005,福州市,福建医科大学附属第一医院病案室  
姚静 350005,福州市,福建医科大学附属第一医院麻醉科  
林财珠 350005,福州市,福建医科大学附属第一医院麻醉科  
陈鹭 350005,福州市,福建医科大学附属第一医院麻醉科 cl165552215@hotmail.com 
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中文摘要:
      
目的 评价不同水平呼气末正压（PEEP）通气对肥胖患者胃减容手术围术期呼吸功能的影响。
方法 选择2018年3月至2019年12月于我院行择期腹腔镜下胃减容手术肥胖患者70例，男43例，女27例，年龄28～52岁，BMI 34~43 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：PEEP 10 cmH2O组（H组）和PEEP 5 cmH2O组（L组），每组35例。记录插管后、气腹及PEEP建立、气腹1、3 h PETCO2、气道峰压（Ppeak）和气道平台压（Pplat）；于麻醉诱导前、气腹1、3 h行血气分析，记录pH、PaO2、PaCO2、肺泡-动脉血氧分压差（A-aDO2）、生理无效腔（VD/VT）、氧合指数（OI）；于麻醉诱导前、术后入PACU、术后1、3 d行床旁肺超声，记录双侧上、下蓝点与后侧壁肺泡胸膜综合征（PLAPS）点改良肺通气评分；记录术后7 d内低氧血症、肺不张、肺炎、呼吸功能不全等肺部并发症发生情况。
结果 与L组比较，H组插管后、气腹及PEEP建立、气腹1、3 h的Ppeak和Pplat明显增高（P<0.05）；在术后入PACU和术后1 d左PLAPS点、右PLAPS点改良肺通气评分和总分明显降低（P<0.05）。两组其他呼吸功能、血气分析和术后肺部并发症发生情况差异无统计学意义。
结论 PEEP 10 cmH2O可有效改善肥胖患者围术期肺通气，但并不能进一步改善该类患者术中呼吸功能和术后肺部并发症发生情况。
英文摘要:
      
Objective To evaluate the effect of different levels of positive end expiratory pressure (PEEP) on perioperative respiratory function in the obese patients undergoing laparoscopic bariatric surgery.
Methods Seventy obese patients, 43 males and 27 females, aged 28 - 52 years, BMI 34-43 kg/m2, ASA physical status Ⅱ or Ⅲ, scheduled for selective laparoscopic bariatric surgery were enrolled. Patients were randomly assigned to two groups receiving PEEP 10 cmH2O (group H) and PEEP 5 cmH2O (group L). Partial pressure of end-tidal carbon dioxide (PETCO2), peak airway pressure (Ppeak), and plateau pressure (Pplat) were recorded from post-intubation, pneumoperitoneum and PEEP, 1 and 3 hours after pneumoperitoneum. Arterial blood gas was analyzed and calculated the pH, partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), A-aDO2, VD/VT and oxygenation index (OI) before induction, 1 hour after pneumoperitoneum, and 3 hours after pneumoperitoneum. Bedside lung ultrasound evaluated the ventilation on upper blue points, lower blue points, and PLAPS points, which were recorded before induction, entering PACU, 1 day after operation, and 3 days after operation. Besides, pulmonary complications including hypoxia, atelectasis, pneumonia and respiratory insufficiency during postoperative 7 days were recorded.
Results Compared with group L, Ppeak and Pplat were significantly increased after intubation, pneumoperitoneum and PEEP, 1 hour after pneumoperitoneum, 3 hours after pneumoperitoneum, and the total ventilation score and that at bilateral PLAPS were statistically lower on entering PACU and 1 day after opertaion in group H (P < 0.05). The other circulatory, respiratory, and blood gas parameters, as well as other postoperative pulmonary complications were similar.
Conclusion High level PEEP 10 cmH2O improves perioperative function of pulmonary ventilation; however, it doesn't show any further superiorities on intraoperative respiratory function and postoperative pulmonary complications in the obese patients.
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