【摘要】 目的观察二氧化碳气腹期间不同呼气末正压通气(PEEP)对肺内分流的影响。方法35例ASAⅠ或Ⅱ级经腹腔镜行中、上腹部手术的病人,随机分为P0组(不予PEEP)、P1组(予4mm Hg PEEP)、P2组(予7mm Hg PEEP)及P3组(予9mm Hg PEEP)。观察注气前5min、注气后30、60、120min的SBP、DBP、HR、SpO2、PETCO2及血气分析。结果与注气前5min比较,四组注气后30min SBP、DBP均显著增高、HR均显著增快(P<0.05或P<0.01);P3组注气后60、120min仍高于注气前(P<0.05或P<0.01),并且其HR、DBP高于P0组(P<0.05或P<0.01)。P0、P1、P3三组注气后PaCO2、动脉血-呼气末二氧化碳分压差(Pa-ETCO2)、肺泡氧分压-动脉血氧分压差(A-aDO2)均显著增高(P<0.05或P<0.01),PaO2注气后30、120min显著降低(P<0.05或P<0.01);P2组差异无统计学意义,并且其PaO2高于P0组,PaCO2、Pa-ETCO2、A-aDO2均低于P0组(P<0.05或P<0.01)。P2、P3两组注气后吸气峰压(Ppeak)均显著增高(P<0.01),并高于P0组(P<0.05或P<0.01)。结论气腹期间采用7mm Hg PEEP的通气模式能有效改善肺的换气功能,且对循环功能的影响较小。更多还原

【Abstract】 Objective To investigate the effect of positive end-expiratory pressure (PEEP) on intrapulmonary shunt during pneumoperitoneum. Methods Thirty-five ASA Ⅰ or Ⅱ patients undergoing laparoscopic operation of upper-abdominal and middle-abdominal region were randomly allocated to four groups with 10 cases in former three groups and 5 in the last . The patients in group P1 were given a constant PEEP of 4 mmHg. The application of PEEP in group P2 and group P3 were respectively 7 mmHg and 9 mmHg,while no PEEP was applied in group P0 during mechanical ventilation. SBP,DBP,HR,SpO2,PETCO2,inspiratory peak pressure (Ppeak) and arterial blood gas recorded at the following time points: before pneumoperitoneum,at 30 min,60 min,and 120 min into pneumoperitoneum. Results SBP,DBP and HR increased significantly (P<0.05 or P<0.01)at 30 min compared to before inflation in four groups,DBP and HR still increased significantly (P<0.05 or P<0.01)at 60 and 120 min in group P3 and were more than those in group P0(P<0.05 or P<0.01). PaCO2,arterial-end-expired CO2 difference (Pa-ETCO2) and alveolar-arterial oxygen difference(A-aDO2) increased significantly at 30,60 and 120 min,and PaO2 at 30 and 120 min after inflation in group P0,P1 and P3(P<0.05 or P<0.01),while those did not change significantly in group P2 and were less than those in group P0(P<0.05 or P<0.01). PaO2 in group P2 were more than those in group P0(P<0.05 or P<0.01). Ppeak increased significantly after inflation in group P2 and P3 and were more than those in group P0(P<0.05 or P<0.01). Conclusion A constant PEEP of 7 mmHg improves intrapulmonary shunt and oxygenation during pneumoperitoneum without depression of hemodynamics.更多还原