文章摘要
不同通气模式对腹腔镜肝切除术患者出血量和术后肝功能的影响
Effects of different ventilation mode types on intra-operative blood loss and postoperative liver function in patients undergoing laparoscopic hepatectomy
  
DOI：10.12089/jca.2023.01.002
中文关键词: 腹腔镜肝切除术  压力控制通气  容量控制通气  吸气峰压  氧合指数
英文关键词: Laparoscopic liver resection  Pressure-controlled ventilation  Volume-controlled ventilation  Peak inspiratory pressure  Oxygenation index
基金项目:中国博士后科学基金资助项目（2019M662179）
作者单位E-mail
张华明 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
杨佳 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
章敏 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
韩明明 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
马骏 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
李启健 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
谢言虎 230001,合肥市,中国科学技术大学附属第一医院麻醉科 xyh200701@sina.cn 
摘要点击次数: 1907
全文下载次数: 647
中文摘要:
      
目的 探讨不同通气模式对腹腔镜肝切除术患者出血量和术后肝功能的影响。
方法 选择择期全麻下行腹腔镜肝切除术患者60例，男35例，女25例，年龄18～64岁，BMI 18.5～24.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：压力控制通气（PCV）组和容量控制通气（VCV）组，每组30例。PCV组通过调整气道峰压，使术中VT达到理想体重×8 ml，同时调整RR维持PETCO2 35～45 mmHg；V组VT设定为理想体重×8 ml，同时调整RR维持PETCO2 35～45 mmHg。记录麻醉诱导后10 min（T0）、气腹后10 min（T1）、切肝前10 min（T2）、切肝后10 min（T3）、气腹结束后10 min（T4）吸气峰压（Ppeak）、气道平均压（Pmean）、CVP、PaCO2和氧合指数（PaO2/FiO2）。记录术中胶体液用量和出血量，术后24、48和72 h丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）以及腹腔引流量。
结果 与T0时比较，T1—T3时两组Ppeak均明显升高（P＜0.05）；T1—T4时VCV组、T3和T4时PCV组CVP均明显升高（P＜0.05）。与VCV组比较，PCV组T1、T2时CVP明显降低（P＜0.05），术中胶体液用量和出血量明显减少（P＜0.05）。两组术后24、48和72 h的ALT、AST和腹腔引流量差异无统计学意义。
结论 压力控制通气模式下腹腔镜肝切除术中患者出血量明显减少，可能与术中较低的气道峰压有关，但两种不同通气模式下患者术后肝功能损伤无明显差异。
英文摘要:
      
Objective To investigate the effects of different types of ventilation mode on intra-operative blood loss and postoperative liver function in patients undergoing laparoscopic hepatectomy.
Methods Sixty patients, 35 males and 25 females, aged 18-64 years, BMI 18.5-24.0 kg/m2, ASA physical status Ⅱ or Ⅲ, who underwent laparoscopic hepatectomy were randomly allocated to receive pressure-controlled ventilation (group PCV, n = 30) and volume-controlled ventilation (group VCV, n = 30) during general anesthesia. Group PCV: the tidal volume was set through adjusting the peak airway pressure, so that the tidal volume of patients during operation was the ideal weight × 8 ml, and the respiratory rate was adjusted to maintain PETCO2 between 35 and 45 mmHg. Group VCV: the ideal weight × 8 ml was used to set the tidal volume of patients during operation, regardless of the airway pressure, and the respiratory rate was adjusted to maintain PETCO2 between 35 and 45 mmHg. The peak inspiratory pressure (Ppeak), mean airway pressure (Pmean), CVP, partial pressure of carbon dioxide (PaCO2), oxygenation index (PaO2/FiO2) were measured for each patient 10 minutes after anesthesia induction (T0), 10 minutes after pneumoperitoneum (T1), 10 minutes before hepatectomy (T2), 10 minutes after hepatectomy (T3), and 10 minutes after pneumoperitoneum (T4). The intraoperative blood loss, transfusion volume, and urine volume during the operation were recorded. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and abdominal drainage volume were also monitored and recorded 24, 48, and 72 hours after surgery.
Results Compared with T0, Ppeak of both groups was significantly increased at T1-T3(P < 0.05), CVP in group VCV was significantly increased at T1-T4, and in group PCV at T3 and T4(P < 0.05). Compared with group VCV, CVP in group PCV was significantly decreased at T1 and T2 (P < 0.05), the amount of colloid and blood loss in group PCV were significantly decreased (P < 0.05). The two groups showed no significant differences in ALT, AST levels and abdominal drainage volume between the two groups 24, 48, and 72 hours after operation.
Conclusion The low blood loss in patients during laparoscopic hepatectomy in pressure-controlled ventilation mode may be related to the lower intraoperative airway peak pressure, but the postoperative liver function impairment has no different between patients in the two different ventilation modes.
查看全文   查看/发表评论  下载PDF阅读器
关闭