本文選題：呼氣末正壓通氣 + 腹腔鏡手術(shù)�。� 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的：觀察腹腔鏡直腸癌手術(shù)中，PEEP對(duì)血流動(dòng)力學(xué)和呼吸系統(tǒng)的影響。 方法：選取2013年6月～2014年3月于吉林大學(xué)第一醫(yī)院擇期行腹腔鏡直腸癌手術(shù)的患者30例，ASAⅠ～Ⅲ級(jí)。按隨機(jī)數(shù)字表法將30例患者隨機(jī)分為2組：VCV組（n=15）和PEEP組（n=15）。患者入手術(shù)室后，連接監(jiān)護(hù)儀常規(guī)監(jiān)測(cè)，局麻下行橈動(dòng)脈穿刺置管。靜脈誘導(dǎo)后行氣管插管（氣管導(dǎo)管型號(hào)選擇：男性ID=7.5mm；女性ID=7.0mm），連接麻醉機(jī)進(jìn)行機(jī)械通氣。VCV組設(shè)定潮氣量（Vt）為8ml/kg，I/E為1:2，調(diào)整呼吸頻率，維持PETCO235-45mmHg。PEEP組設(shè)定Vt為8ml/kg，PEEP為10cmH2O，I/E為1:2，調(diào)整呼吸頻率，維持PETCO235-45mmHg。兩組的Vt,，I/E，吸入新鮮氣體流量在實(shí)驗(yàn)期間恒定不變。麻醉誘導(dǎo)采取仰臥位，建立人工CO2氣腹，維持氣腹壓14mmHg；然后采取30°Trendelenburg體位；氣腹停止后，恢復(fù)患者體位為仰臥位。記錄患者在氣腹前(T1)、Trendelenburg體位后5min（T2）、Trendelenburg體位后30min(T3)、氣腹停止后5min（T4）的收縮壓(SBP)，舒張壓(DBP)，平均動(dòng)脈壓(MAP)，，心率(HR)，氣道平臺(tái)壓（Pplat），氣道峰壓（Ppeak），呼吸頻率（RR），氧合指數(shù)（PaO2/FiO2，OI），動(dòng)態(tài)肺順應(yīng)性（Cdyn）。在以上各時(shí)間點(diǎn)采集橈動(dòng)脈血行血?dú)夥治觥?結(jié)果：1，兩組患者一般情況及手術(shù)情況無(wú)明顯差別。2，兩組SBP、DBP、MAP在T2和T3時(shí)明顯高于T1（p＜0.05）；HR無(wú)明顯變化。3，兩組Pplat、Ppeak在T2和T3時(shí)明顯高于T1（p＜0.05），兩組RR在T2、T3、T4明顯大于T1（p＜0.05）；兩組之間Pplat、Ppeak和RR無(wú)顯著性差異。4，在各時(shí)間點(diǎn)PEEP組OI明顯高于VCV組（p＜0.05）；PEEP組患者在T2、T3、T4時(shí)Cdyn明顯高于VCV組（p＜0.05）。 結(jié)論：1，在腹腔鏡直腸癌手術(shù)中，PEEP對(duì)血流動(dòng)力學(xué)的影響不顯著。2，與單純VCV相比，在腹腔鏡直腸癌手術(shù)中，PEEP可以在不影響循環(huán)穩(wěn)定的同時(shí)改善動(dòng)脈氧合和動(dòng)態(tài)肺順應(yīng)性。
[Abstract]:Objective: To observe the effect of PEEP on hemodynamics and respiratory system in laparoscopic rectal cancer surgery.
Methods: 30 cases of laparoscopic rectal cancer surgery were selected from June 2013 to March 2014 in the No.1 Hospital of Jilin University, ASA I to grade III. 30 patients were randomly divided into 2 groups according to the random digital table method: group VCV (n=15) and group PEEP (n=15). After the patients entered the operation room, the patients were connected to the monitor routine monitoring, and the radial artery puncture was placed under local anesthesia. After venous induction, the tracheal intubation was performed (the selection of the tracheal tube: male ID=7.5mm; female ID=7.0mm). The volume of tidal gas (Vt) in the mechanical ventilation.VCV group was 8ml/kg, the I/E was 1:2, the respiratory frequency was adjusted, the Vt was 8ml/kg in the PETCO235-45mmHg.PEEP group, PEEP was 10cmH2O, and the respiratory frequency was adjusted to maintain the frequency. Hg. two groups of Vt, I/E, inhaled fresh gas flow constant during the experiment. Anesthesia induction to take the supine position, establish an artificial CO2 pneumoperitoneum, maintain the pneumoperitoneum pressure 14mmHg, and then take 30 degree Trendelenburg position, after the pneumoperitoneum stop, restore the patient's position in the supine position. Record the patient before the pneumoperitoneum (T1), Trendelenburg posture after 5min (T2), Trendele. Nburg post position 30min (T3), 5min (T4) systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), airway pressure (Pplat), airway peak pressure (Ppeak), respiratory frequency (RR), oxygenation index, dynamic pulmonary compliance.
Results: 1, the general situation and operation situation of the two groups were not significantly different.2, the two groups of SBP, DBP, MAP were obviously higher than T1 (P < 0.05) at T2 and T3; HR had no obvious changes in.3, two group Pplat. The two groups were obviously larger than those of the two (0.05); At each time point, OI in group PEEP was significantly higher than that in group VCV (P < 0.05); Cdyn in group PEEP was significantly higher than that in VCV group at T2, T3 and T4 (P < 0.05).
Conclusion: 1, in laparoscopic rectal cancer surgery, the effect of PEEP on hemodynamics is not significant.2. Compared with simple VCV, PEEP can improve arterial oxygenation and dynamic pulmonary compliance without affecting the circulation stability.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.37

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 黃東曉;王雁娟;丁浩中;;全身麻醉中應(yīng)用小潮氣量聯(lián)合低水平呼氣末正壓通氣對(duì)老年患者呼吸功能的影響[J];臨床麻醉學(xué)雜志;2008年06期

2 單紅衛(wèi),楊興易,陳學(xué)云,景炳文;體外循環(huán)術(shù)后早期氧動(dòng)力學(xué)變化[J];中華麻醉學(xué)雜志;1997年06期

3 單紅衛(wèi);氧供給與氧消耗關(guān)系的研究及在危重病人救治中的意義[J];中國(guó)急救醫(yī)學(xué);1995年01期

4 文亮,劉明華;不同水平呼氣末正壓通氣對(duì)急性呼吸窘迫綜合征患者氧合功能和血流動(dòng)力學(xué)的影響[J];中國(guó)危重病急救醫(yī)學(xué);2000年01期

5 ;Laparoscopic total mesorectal excision of low rectal cancer with preservation of anal sphincter:A report of 82 cases[J];World Journal of Gastroenterology;2003年07期

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