喉罩麻醉下压控反比通气在妇科腹腔镜中应用.docVIP

喉罩麻醉下压控反比通气在妇科腹腔镜中应用 　　【摘要】 目的：研究压控反比通气方式对喉罩麻醉下妇科腹腔镜手术患者呼吸动力学的影响。方法：选择30例年龄18～60岁的患者，ASAⅠ～Ⅲ级，计划接受妇科腔镜手术，预期手术时间在45 min以上，使用压控通气模式，吸呼比保持在1：2，PEEP 5 cm H2O，呼吸频率调整在10～12次/min。术中监测无创血压，脉搏血氧饱和度，呼气末正压，5导联肢导心电图等。气腹之后15 min记录数据。此后将吸呼比改为1.5：1，PEEP仍然维持5 cm H2O，反比通气15 min记录数据。结果：压控通气气道峰压在（25.5±3.67）cm H2O，平台压 　　（25.35±3.8）cm H2O。压控反比通气，气道峰压和平台压分别是（25.8±3.86）cm H2O和（25.8±3.41）cm H2O。 　　在压控通气期间平均气道压（13.5±1.35）cm H2O低于压控反比通气时的（17.30±2.08）cm H2O。压控反比通气期间的潮气量（502±49.19）mL也高于压控通气时的（450±38.25）mL。压控反比通气的动态顺应性（24.8±4.25）mL/cm H2O也明显高于压控通气时的（21.50±3.90）mL/cm H2O。结论：吸呼比为1.5：1的压控反比通气在使用喉罩通气的妇科腔镜手术中是一种有效的通气方式。 　　【关键词】 喉罩； 腹腔镜； 压控通气； 压控反比通气 　　Use of Laryngeal Mask Combined with Pressure-controlled Inverse Ratio Ventilation in Gynecological Laparoscopy/CUI Chao， GAO Yu-liang， MAO Wu-de.//Medical Innovation of China，2015，12（04）：021-023 　　【Abstract】 Objective：To investigate the effect of pressure-controlled inverse ratio ventilation using laryngeal mask airway in gynecological laparoscopy.Method：Thirty patients between 18 and 60 years， American Society of Anesthesiologists class 1-3， scheduled for elective major gynecological laparoscopy were included in the study.Size 4 flexible LMAs were used for patients.Pressure-controlled ventilation （PCV） was initiated with tidal volume 8 mL/kg， 　　inspiratory?Cexpiratory （I：E） ratio was kept 1：2， with positive end expiratory pressure （PEEP） of 5 cm H2O.Intraoperative monitoring included noninvasive blood pressure， pulse oximetry， end-tidal carbon dioxide， 5-lead EKG， gas monitoring.After 15 min of pneumoperitoneum readings were recorded.I：E ratio was now changed to 1.5：1 on the mode PCV （PCIRV） and PEEP of 5 cm H2O continued.Readings were taken after 15 min of PCIRV.Result：The peak and plateau pressures after pneumoperitoneum during PCV was （25.5±3.67） and （25.35±3.8） cm H2O， respectively and during PCIRV （25.8±3.86） and （25.8±3.41） cm H2O， respectively， and was statistically similar.The mean airway pressure during PCV （13.5±1.35） cm H2O was lower