【摘要】 目的观察肥胖患者行全麻腹腔镜手术时,不同的机械通气模式对病人氧合情况的影响。方法选择60例行腹部腹腔镜手术的肥胖患者,按手术日期分为3组:容量控制通气(volume control ventilation,VCV)组,压力控制通气(pressure control ventilation,PCV)组,压力控制通气联合呼气末正压通气(pressure control ventilation and positive end expiratorypressure,PCV+PEEP)组,每组20例。分别于手术开始气腹后30min(T1)、气腹后60min(T2)、手术结束后拔气管插管后30min(T3)、拔气管插管后60min(T4),采血测定pH、PCO2、氧合指数、肺内分流率。结果PCV+PEEP组T1时点氧合指数429.35±51.88显著高于VCV组346.15±54.48(q=6.771,P<0.05)和PCV组393.50±58.34(q=2.918,P<0.05),T4时点氧合指数231.87±20.47显著高于VCV组211.50±12.52(q=5.172,P<0.05)和PCV组220.12±18.84(q=2.983,P<0.05)。PCV+PEEP组T1、T2、T3、T4的肺内分流率分别为(10.94±1.40)%、(11.17±1.42)%、(10.24±1.22)%、(9.92±1.09)%显著低于VCV组(12.09±1.41)%、(12.67±1.76)%、(11.64±1.44)%、(11.34±1.38)%(q=3.771,P<0·05;q=4.772,P<0.05;q=4.872,P<0.05;q=4.772,P<0.05)。HR、MAP3组不同时点比较无明显差异(P>0·05)。结论行腹腔镜手术时,压力控制通气联合呼气末正压通气可以显著提高肥胖患者的氧合情况。更多还原

【Abstract】 Objective To observe oxygenation status when different modes of mechanical ventilation were actualized during laparoscopic operations in obese patients. Methods Sixty obese patients for laparoscopy were divided into three groups with 20 patients in each group, receiving volume controlled ventilation （VCV Group）, or pressure controlled ventilation （PCV Group）, or pressure controlled ventilation with positive end-expiratory pressure （PCV+PEEP Group）. Levels of pH value, PCO₂, PO₂/FiO₂, and Qs/Qt were measured at 30 min after pneumoperitoneum （T1）, 60 min after pneumoperitoneum （T2）, 30 min after extubation （T3）, and 60 min after extubation （T4）, respectively. Results The oxygenation index was significantly higher in the PCV+PEEP Group at T1 （429.35±51.88） and T4 （231.87±20.47） than in the VCV Group at T1 （346.15±54.48; q=6.771, P<0.05） and T4 （211.50±12.52; q=5.172, P<0.05）, and in the PCV Group at T1 （393.50±58.34; q=2.918, P<0.05） and T4 （220.12±18.84; q=2.983, P<0.05）, respectively. The Qs/Qt ratios were significantly lower in the PCV+PEEP Group than in the VCV Group at T1 （10.94±1.40% vs 12.09±1.41%; q=3.771, P<0.05）, T2 （11.17±1.42% vs 12.67±1.76%; q=4.072, P<0.05）, T3 （10.24±1.22% vs 11.64±1.44%; q=4.872, P<0.05）, and T4 （9.92±1.09% vs 11.34±1.38%; q=4.772, P<0.05）, respectively. Conclusions Oxygenation level can be improved by pressure controlled ventilation and positive end-expiratory pressure during laparoscopy in obese patients.更多还原