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当代医学 2018年5月第24卷第14期总第493期 Contemporary Medicine, May.2018,Vol.24 No.14 Issue No.493麻醉诱导期开始采用肺保护性通气策略对妇科腔镜手术患者呼吸力学及肺氧合功能的影响黄永军，范华荣，陈晓燕（滨州市沾化区人民医院麻醉科，山东 滨州 256800）摘要：目的 探讨麻醉诱导期开始采用肺保护性通气策略对妇科腔镜手术患者呼吸力学及肺氧合功能的影响。方法 选择行妇科腔镜手术的患者110例，随机分为A，B，C 3组，每组40例。麻醉诱导后进行不同的通气策略，A组为全手术期间均以潮气量10 ml/kg；B组为低VT组，以潮气量（VT）7 ml/kg；C组为低VT组+低PEEP+肺复张手法组，即全程使用VT 7 ml/kg，PEEP 5 cmH 2 O，同时每30 min进行一次手法肺复张。记录麻醉前，手术开始30 min，手术中60 min，90 min，手术结束后120 min的气道峰压（P peak ），气道平台呀（P plat ），肺顺应性，并且在同一时间抽取患者动脉血进行血气分析，计算氧合指数和肺内分流率。结果 3组患者的P peak ，CL值均随着时间延长而逐渐增高，但B组与C组升高趋势明显低于A组（ P ＜0.05）；3组患者的P plat ，OI值均随着时间延长而逐渐减少，但B组与C组降低趋势明显高于A组（ P ＜0.05）；同时在同一时间段，C组要低于B组，两组之间差异有统计学意义（ P ＜0.05）。结论 在妇科腔镜手术患者中，相较于传统的大潮气量通气策略，麻醉诱导期开始采用肺保护性通气策略对呼吸力学及肺氧合功能的改善更为明显。关键词：肺保护性通气策略；妇科腔镜手术；呼吸力学；肺氧合功能The effects of pulmonary protective ventilation strategyon respiratory mechanics and oxygenation function inpatients with gynecologic endoscopic surgery wereintroducedHuang Yongjun, Fan Huarong, Chen Xiaoyan(Department ofAnesthesiology, People's Hospital of Zhanhua, Binzhou, Shandong, 256800, China)Abstract: Objective To explore the effect of pulmonary protective ventilation strategy on respiratory mechanics and oxygenation function inpatients with gynecologic endoscopic surgery. Methods 110 patients with gynecological endoscopic surgery were selected, randomly divided into A,B and C groups, with 40 cases in each group. After anesthesia induction, different ventilation strategies were carried out. In group A, the air volumewas 10 ml/kg during the whole operation. Group B was low VT group, with tidal volume (VT) 7 ml/kg; Group C was a group of low VT group + lowPEEP + lung complex, that is, the whole process was using VT 7 ml/kg, PEEP 5 cmH 2 O, and every 30 min was used for pulmonary resection. Recordbefore anesthesia and surgery began 30 min, in 60 min, 90 min, 120 min after the operation of the airway peak pressure (P peak ), airway platform (P plat ),lung compliance, and at the same time extraction in patients with arterial blood for blood gas analysis, calculating oxygenation index, and pulmonaryFenLiuLv inside. Results P peak of three groups of patients’s CL values are gradually increased, but in group B and C group with prolonged risingtrend, was obviously lower than that of group A (P＜0.05); In 3 patients P plat , OI values gradually decreased with time extend, reducing trend in groupB and C group was obviously higher than that of group A (P＜0.05), while at the same time, lower than group B, group C was statistically significantdifference between the two groups (P＜0.05). Conclusion In patients with gynecological endoscopy surgery, compared with the traditional springtide volume ventilation strategy, anesthesia induction period began to adopt the strategy of lung protective ventilation on respiratory mechanics andpulmonary oxygenation function of improvement is more apparent.Key words: Lung protective ventilation strategy; Gynecologic endoscopic surgery; Respiratory mechanics; Oxygenation腔镜术是一种新型的微创手术，随着近年来我国科技水平及医疗手术的提升，腔镜术在妇产科手术中广泛的使用。由于腔镜术具有对患者造成的损伤小、患者疼痛程度低、并发症少、恢复快等优点，受到了患者的青睐。但由于患者在进行腔镜手术时需要建立气腹，CO 2 气腹是目前最常用的妇科腔镜手术人工气腹的方法，但是其对患者呼吸系统影响很大 [1] 。为了保证妇科腔镜手术中患者足够的通气量，维持患者的生理循环功能及体内环境平衡，通常的方式是通过大潮气量来实现，但是这就会引起肺泡体积增大，气道压力过高等损伤 [2] 。肺保护性通气策略（lung protective ventila-tion strategy，LPVS）是一种通过小潮气量，低平台压以及适度的呼吸末正压（positive endexpiratory pressure，doi:10.3969/j.issn.1009-4393.2018.14.026 --论著--— — 69