不同通气策略对截石位腹腔镜手术老年患者肺内分流的影响

Effects of Different Ventilation Strategies on Intrapulmonary Shunt of Elderly Patients Undergoing Laparoscopic Surgery in Lithotomy position

中文关键词: 通气策略  氧合功能  估计动静脉混合指数  肺内分流

英文关键词: protective ventilation strategy  oxygenation  estimated venous admixture (EVA)  intrapulmonary shunt

中文摘要:

      目的 比较不同通气策略对于行截石位腹腔镜手术的老年患者肺内分流的影响.方法 选取60例截石位下行腹腔镜肠道手术的老年患者,随机分为A1组、A2组和C组.在预给氧期和诱导期,A1组和A2组给予100％ FiO2+ 8cmH2O持续正压通气(continuous positive airway pressure,CPAP),C组给予100％ FiO2+ 0cmH2O CPAP.麻醉维持期3组均给予40％ FiO2+8cmH2O PEEP.气管拔管前1/2h,A1组给予30％FiO2+8 cmH2O PEEP,A2组和C组给予100％ FiO2+ 8cmH2OPEEP.所有患者均在麻醉前(T1)、气管插管后1Omin(T2)、关气腹时(T3)、气管拔管后1h (T4)行血气分析.计算各个时点的氧合指数以及估计动静脉混合指数(estimated venous admixture,EVA).结果 3组患者在T2、T3时点的氧合指数及EVA值差异无统计学意义.A1组T4时点的氧合指数(460±80) mmHg高于A2组(370±40) mmHg和C组(380±70) mmHg,A1组T4时点的EVA值(10％±6％)低于A2组(18％±7％)和C组(18％±7％).结论 截石位下行腹腔镜手术的老年患者在苏醒期吸人纯氧可加重肺内动静脉分流,影响氧合功能.

英文摘要:

      Objective To compare the effects of different ventilation strategies on intrapulmonary shunt of elderly patients undergoing laparoscopic surgery in lithotomy position.Methods Sixty elderly patients undergoing laparoscopic surgery in lithotomy position were selected and randomly divided into 3 groups:group A1,group A2 and group C,20 in each.During pre-oxygenation and anesthesia induction,patients in the group A1 and the group A2 received 100％ FiO2 + 8 cmH2O CPAP (continuous positive airway pressure) while patients in the group C received 100 ％ FiO2 + 0 cmH2O CPAP.During anesthesia maintanance,patients in the 3 groups all received 40％FiO2 + 8 cmH2O PEEP (positive end expiratory pressure);Thity minutes before extubation,patients in the group A1 received 30％FiO2 + 8 cmH2O PEEP while patients in the group A2 and the group C received 100％FiO2 + 8 cmH2O PEEP.Blood gas analysis was made in all patients in the 3 groups at the time point of T1 (before anesthesia),T2 (10 minutes after intubation),T3 (at the cessation of insufflation) and T4 (1 hour after extubation).The oxygenation index and the estimated venous admixture (EVA) at each time point were calculated.Results There existed no difference of statistical signif1icance in oxygenation index and EVA at T2 and T3 among the patients in the 3 groups;the oxygenation index of the patients in the group A1 at T4 was higher (460±80mmHg) than that in the group A2 (370±40mmHg) and that in the group C (380±70mmHg) while the EVA of the patients in the group A1 at T4 was lower (10％ ±6％) than that in the group A2 (18％ ±7％) and that in the group C (18％ ±7％).Conclusions Inhalation of pure oxygen during recovery for elderly patients undergoing laparoscopic surgery in lithotomy position may aggravate intrapulmonary shunt and make oxygenation deteriorated.