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中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 250 -254. doi: 10.3877/cma.j.issn.2095-9605.2021.04.006

论著

呼气末正压通气水平对肥胖腹腔镜结肠癌根治术患者术中呼吸功能的影响
尹晓旭1, 李静2,()   
  1. 1. 516001 惠州,广东省惠州市中心人民医院麻醉科
    2. 710000 西安,西安医学院第二附属医院麻醉科
  • 收稿日期:2021-08-24 出版日期:2021-11-30
  • 通信作者: 李静

The effect of positive end-expiratory pressure on the respiratory function in obese patients undergoing laparoscopic radical resection of colon cancer.

Xiaoxu Yin1, Jing Li2,()   

  1. 1. Department of Anesthesiology, Huizhou Central People's Hospital, Huizhou, 516001
    2. Department of Anesthesiology, Second Affiliated Hospital of Xi’an Medical College, Xi’an 710000, China
  • Received:2021-08-24 Published:2021-11-30
  • Corresponding author: Jing Li
引用本文:

尹晓旭, 李静. 呼气末正压通气水平对肥胖腹腔镜结肠癌根治术患者术中呼吸功能的影响[J/OL]. 中华肥胖与代谢病电子杂志, 2021, 07(04): 250-254.

Xiaoxu Yin, Jing Li. The effect of positive end-expiratory pressure on the respiratory function in obese patients undergoing laparoscopic radical resection of colon cancer.[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(04): 250-254.

目的

对比不同水平呼气末正压(PEEP)通气对肥胖腹腔镜结肠癌根治术患者围术期呼吸功能的影响。

方法

选取惠州市中心人民医院2020年1月至2021年5月行腹腔镜结肠癌根治术的肥胖患者共80例,随机分为两组:PEEP 10 cm H2O组(高通气组)和PEEP 5 cm H2O组(低通气组),每组40例。记录插管后、气腹及PEEP建立、气腹2 h的PETCO2、气道峰压(Ppeak)和气道平台压(Pplat);记录不同时间点的血气分析情况,以及改良肺通气评分;记录所有患者术后7 d内肺部并发症发生情况。

结果

高通气组和低通气组的患者其手术时间、气腹压力、术中出血、去甲肾上腺素使用量对比差异均无统计学意义(P>0.05);两组之间的不同时间点的HR、SBP和DBP水平对比差异无统计学意义(P>0.05),高通气组的Ppeak和Pplat水平在气腹及PEEP建立、气腹2 h水平显著高于低通气组(P<0.05),两组不同时间点的酸碱度(pH)、动脉氧分压(PaO2)、二氧化碳分压(PaCO2)和氧合指数(OI)水平对比差异无统计学意义(P>0.05),两组术后肺部相关并发症发生率差异无统计学意义(P>0.05)。

结论

高PEEP通气在肥胖腹腔镜结肠癌根治术患者应用能提高围术期肺通气水平,但未能提高患者术的呼吸功能和减少术后肺部相关并发症的发生。

Objective

To compare the effects of different levels of positive end expiratory pressure (PEEP) ventilation on the perioperative respiratory function of obese patients undergoing laparoscopic radical resection of colon cancer.

Methods

A total of 80 obese patients who underwent laparoscopic radical resection of colon cancer at Huizhou Central People's Hospital from January 2020 to May 2021 were randomly divided into two groups: PEEP 10 cmH2O group (high ventilation group) and PEEP 5 cm H2O group (hypoventilation group), 40 cases in each group. Record PETCO2, peak airway pressure (Ppeak) and airway plateau pressure (Pplat) after intubation, establishment of pneumoperitoneum and PEEP, 2 hours of pneumoperitoneum; record blood gas analysis at different time points, and improve lung ventilation score; record all patients Pulmonary complications occurred within 7 days after operation.

Results

There was no statistically significant difference in operation time, pneumoperitoneum pressure, intraoperative bleeding, and norepinephrine usage in patients in the hyperventilation group and the hypoventilation group (P>0.05); but the different time between the two groups There was no significant difference in the levels of HR, SBP, and DBP at points (P>0.05). The levels of Ppeak and Pplat in the high-ventilation group were significantly higher in the pneumoperitoneum and PEEP, and the pneumoperitoneum 2 h level was significantly higher than that in the hypoventilation group (P<0.05) However, there was no statistically significant difference in Acidity (pH), arterial oxygen partial pressure (PaO2), carbon dioxide partial pressure (PaCO2) and oxygenation index (OI) levels between the two groups at different time points (P>0.05), and there was no significant difference in the incidence of postoperative lung-related complications between the two groups (P>0.05).

Conclusions

High PEEP ventilation in obese patients undergoing laparoscopic radical colon cancer surgery can improve the level of perioperative lung ventilation, but it fails to improve the patient’s respiratory function and reduce the incidence of postoperative lung-related complications.

表1 两组患者一般资料比较
表2 两组患者手术指标比较
表3 两组患者手术期间生命体征指标对比
表4 两组患者术中不同时间点的通气情况比较
表4 两组患者术中不同时间点的血气情况比较
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