[1]高宪,黄艰,杨贞,等.小潮气量通气对腹腔镜下肝部分切除术患者循环功能的影响[J].第三军医大学学报,2019,41(21):2114-2119.
 GAO Xian,HUANG Jian,YANG Zhen,et al.Effects of low tidal volume ventilation on circulatory function in patients undergoing laparoscopic liver resection[J].J Third Mil Med Univ,2019,41(21):2114-2119.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第21期
页码:
2114-2119
栏目:
临床医学
出版日期:
2019-11-15

文章信息/Info

Title:
Effects of low tidal volume ventilation on circulatory function in patients undergoing laparoscopic liver resection
作者:
高宪黄艰杨贞朱圆向伦理鲁开智甯交琳
400038 重庆,陆军军医大学(第三军医大学)第一附属医院麻醉科
Author(s):
GAO Xian HUANG Jian YANG Zhen ZHU Yuan XIANG Lunli LU Kaizhi NING JiaolinDepartment of Anaesthesiology First Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing 400038 China

GAO Xian, HUANG Jian, YANG Zhen, ZHU Yuan, XIANG Lunli, LU Kaizhi, NING JiaolinDepartment of Anaesthesiology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
腹腔镜肝癌切除术术中循环管理全身麻醉  
Keywords:
laparpscopic liver resection intraoperative anesthesia circulation management general anesthesia
分类号:
R331.3; R614; R657.3
文献标志码:
A
摘要:

目的比较小潮气量通气和常规潮气量通气对腹腔镜下肝脏切除手术过程中循环功能的影响。方法纳入2017年7-12月于我院计划接受腹腔镜下肝部分切除术患者22例,按随机数字表法分为2组(n=11),常规潮气量组(conventional tidal volume,CTV)和小潮气量组(low tidal volume,LTV)采取相同麻醉诱导、维持方案。CTV组患者接受常规潮气量通气[10~12 mL/kg(理想体质量)、无呼气末正压通气(positive end expiratory pressure,PEEP)、无手法复张],LTV组患者接受小潮气量通气[6~8 mL/kg(理想体质量)、无PEEP、每30 min采用手法复张1次,每次将气道压维持在30 cmH2O,持续30 s,3个循环]。比较两组病例不同时相点每博量变异度(stroke volume variance, SVV)、中心静脉压(central venous pressure, CVP)、心脏指数(cardiac index ,CI)、外周血管阻力指数(systemic vascular resistance index, SVRI)、平均动脉压(mean artery blood pressure, MAP)、心率(heart rate, HR)等术中循环指标、术中血管活性药物的使用量以及术后外科医师对术中麻醉循环管理评分。结果①LTV组需要输注去甲肾上腺素维持血压的患者少于CTV组(1 vs 8例,P<0.05);②在气腹建立后,CTV(22.6±6.2 vs 13.3±3.6,P<0.01)和LTV(17.2±6.4 vs 13.0±3.9,P<0.05)组患者SVV均明显高于气腹建立前水平;人工气腹建立期间,LTV组SVV均低于CTV组,人工气腹建立后第15 min(T3:17.2±6.4 vs 22.6±6.2,P<0.05)及第30 min(T4:17.1±4.0 vs 22.1±5.8,P<0.05),两组间比较差异具有统计学意义;③在气腹建立后即刻,CTV(2.7±1.6 vs 5.6±2.0 cmH2O,P<0.05)和LTV组患者CVP均降低,在整个人工气腹过程中均低于气腹建立前水平,自身前后对照比较无统计学差异;④术后外科医师对术中麻醉循环管理评分LTV组明显高于CTV组(3.7±0.8 vs 3.1±0.5,P<0.05)。结论与常规潮气量通气比较,小潮气量通气可减低人工气腹对腹腔镜肝部分切除术患者术中循环功能的影响,有利于循环稳定、便于外科医师手术操作。

Abstract:

Objective To compare the effect of low tidal volume (LTV) ventilation versus conventional tidal volume (CTV) ventilation on circulatory function in patients undergoing laparoscopic liver resection (LLR).  MethodsA total of 22 patients who underwent selective LLR in our hospital from July to December 2017 were enrolled into this study. They were prospectively randomized to CTV group (n=11) and LTV group (n=11). They all received same anesthesia induction and maintenance, and those of the CTV group underwent conventional mechanical ventilation (tidal volume: 10~12 mL/kg) without positive end expiratory pressure (PEEP) or recruitment maneuver, while those of the LTV group were given mechanical ventilation with lower tidal volume (6~8 mL/kg) along with recruitment maneuver (once/30 min) but no PEEP during operation, with the airway pressure being maintained at 30 cmH2O for 30 s at a time for 3 cycles. The intraoperative circulation indexes including stroke volume variance (SVV), central venous pressure (CVP), cardiac index (CI), systemic vascular resistance index (SVRI), mean artery pressure (MAP), heart rate (HR),  doses of vasopressor usage, and score of intraoperative anesthesia circulation management made by surgeons postoperatively were compared between the 2 groups. Results① There were less patients receiving norepinephrine to maintain MAP in the CTV group than the LTV group (1 vs 8 cases, P<0.05). ②After the establishment of pneumoperitoneum, SVV was significantly elevated in the CTV group (22.6±6.2 vs 13.3±3.6, P<0.01) and the LTV group (17.2±6.4 vs 13.0±3.9, P<0.05) when compared with that before establishment. SVV was lower in the LTV group than the CTV group during the phase of establishment, with statistical differences at 15 (17.2±6.4 vs 22.6±6.2, P<0.05) and 30 min (17.1±4.0 vs 22.1±5.8, P<0.05) after the establishment of pneumoperitoneum. ③ CVP was decreased in the LTV group than the CTV group (2.7±1.6 vs 5.6±2.0 cmH2O) immediately after the establishment of pneumoperitoneum when compared with baseline, though without significant difference. ④ The score of intraoperative anesthesia circulation management was notably higher in the LTV group than the CTV group (3.7±0.8 vs 3.1±0.5, P<0.05). ConclusionLTV ventilation reduces the adverse effects of pneumoperitoneum on hemodynamics in the patients undergoing LLR when compared with CTV ventilation, and is facilitated to stabilization of hemodynamics and better operating conditions for surgeons.

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更新日期/Last Update: 2019-11-12