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| 不同通气模式对妇科腹腔镜手术患者膈肌功能的影响 |
| Effects of different ventilation modes on diaphragm function in patients undergoing laparoscopic gynecological surgery |
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| DOI：10.12089/jca.2023.11.001 |
| 中文关键词: 膈肌超声 膈肌功能障碍 压力控制通气 膈肌移动度 膈肌收缩速度 |
| 英文关键词: Diaphragm ultrasound Diaphragm dysfunction Pressure controlled ventilation Diaphragmatic excursion Ddiaphragm contraction velocity |
| 基金项目:江苏省无锡市卫健委重大科研项目（Z202211）；江苏省无锡市妇幼健康适宜技术推广项目（FYTG202201） |
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| 中文摘要: |
目的 探讨压力控制通气（PCV）和容量控制通气（VCV）模式对妇科腹腔镜手术患者术后膈肌功能以及术后肺部并发症（PPCs）发生率的影响。
方法 选择择期全麻下行妇科腹腔镜手术患者66例，年龄18～64岁，BMI 18～30 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：PCV通气模式组（P组）和VCV通气模式组（V组），每组33例。麻醉诱导完成后均使用VCV通气，P组在气腹开始后切换为PCV至手术结束；V组在气腹开始后维持VCV直至手术结束。记录机械通气时间、人工气腹时间、气腹结束至拔管时间、苯磺顺阿曲库铵总量、拔管后即刻警觉/镇静观察评分（OAA/S评分）。记录麻醉诱导前、拔管后即刻、拔管后30 min的膈肌移动度（DE）、膈肌收缩速度（DCV）、膈肌浅快呼吸指数（D-RSBI）。记录拔管后即刻和拔管后30 min后膈肌功能障碍发生率、术后第1～3天PPCs发生率。
结果 与V组比较，P组拔管后即刻DE明显增快（P＜0.05），拔管后即刻和拔管后30 min DCV明显增快（P＜0.05），术后第1天PPCs发生率明显降低（P＜0.05）。两组D-RSBI、机械通气时间、人工气腹时间、气腹结束至拔管时间、苯磺顺阿曲库铵总量、拔管后即刻OAA/S评分、拔管后即刻和拔管后30 min的膈肌功能障碍发生率、术后第2、3天PPCs发生率差异无统计学意义。
结论 在妇科腹腔镜手术中，与使用容量控制通气模式比较，使用压力控制通气模式不能降低术后膈肌功能障碍的发生率，但可以减轻患者膈肌吸气力量的减弱，降低术后第1天肺部并发症的发生率。 |
| 英文摘要: |
Objective To study the effects of pressure controlled ventilation (PCV) and volume controlled ventilation (VCV) on diaphragm function and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing laparoscopic surgery.
Methods Sixty-six patients underwent laparoscopic gynecological surgery under general anesthesia, aged 18-64 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ were recruited. The patients were randomly divided into two groups: PCV group (group P) and VCV group (group V), 33 cases in each group. All the patients were ventilated in VCV mode after induction. Group P was switched to PCV after pneumoperitoneum and group V maintained VCV until the end of operation after pneumoperitoneum. The diaphragm ultrasonic evaluation indexes including diaphragmatic excursion (DE), diaphragm contraction velocity (DCV), and diaphragmatic rapid shallow breathing index (D-RSBI) were recorded before anesthesia induction, immediately after extubation, and 30 minutes after extubation. The mechanical ventilation time, artificial pneumoperitoneum time, the time from the end of artificial pneumoperitoneum to extubation, the cumulative dosage of cisatracuriumbesylate, and the patient's observer's assessment alert/sedation (OAA/S) immediately after extubation, the incidence of diaphragm dysfunction immediately after extubation and 30 minutes after extubation, and the cumulative incidence of PPCs in 1-3 days after operation.
Results Compared with group V, DE in group P was increased significantly immediately after extubation (P < 0.05), but there was no significant difference in DE of 30 minutes between the two groups after extubation. Compared with group V, DCV in group P was increased significantly immediately after extubation and 30 minutes after extubation (P < 0.05), the incidence of PPCs in group P was significantly lower on the 1st day after operation (P < 0.05). There were no significant differences in D-RSBI, time of mechanical ventilation, time of artificial pneumoperitoneum, time from the end of pneumoperitoneum to extubation, cumulative dosage of atracurium besylate, OAA/S score immediately after extubation, and the incidence of diaphragm dysfunction immediately after extubation and 30 minutes after extubation, and the cumulative incidence of PPCs on the 2nd and 3rd day after operation.
Conclusion In lower abdominal endoscopic gynecological surgery, compared with volume-controlled ventilation mode, pressure-controlled ventilation mode dose not reduce the incidence of postoperative diaphragm dysfunction, but dose alleviate the weakening of diaphragm inspiratory force and reduce the incidence of pulmonary complications on the first day after operation. |
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