Effects of mechanical ventilation with lower tidal volume and positive end-expiratory pressure on pulmonary function during laparoscopic surgery in patients with chronic obstructive pulmonary disease
10.3760/cma.j.issn.0254-1416.2013.10.020
- VernacularTitle:低潮气量联合呼气末正压通气对慢性阻塞性肺疾病患者腹腔镜手术时肺功能的影响
- Author:
Zhiyuan CHEN
;
Jianhua WU
;
Yuzhen WANG
;
Yan LI
;
Xiaoting XU
- Publication Type:Journal Article
- Keywords:
Positive-pressure respiration;
Tidal volume;
Respiration,artificial;
Respiratory function tests;
Pulmonary disease,chronic obstructive;
Laparoscopy
- From:
Chinese Journal of Anesthesiology
2013;33(10):1229-1232
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of mechanicl ventilation with lower tidal volume and positive end-expiratory pressure (PEEP) on pulmonary function during laparoscopic surgery in patients with chronic obstructive pulmonary disease (COPD).Methods Forty patients with COPD,aged 60-82 yr,with body mass index of 16-29 kg/m2,undergoing elective laparoscopic surgery,were randomly divided into 2 groups (n =20 each) using a random number table:conventional ventilation group (group Ⅰ) and mechanical ventilation with lower tidal volume and PEEP group (group Ⅱ).Anesthesia was induced with midazolam,sufentanil,cisatracurium and propofol and maintained with iv infusion of propofol,cisawacurium and remifentanil.The patients were endotracheally ventilated and mechanically ventilated.In group Ⅰ,fresh gas flow was set at 2 L/min,VT at 10 ml/kg,and I∶E at 1∶2 during ventilation.In group Ⅱ,fresh gas flow was set at 2 L/min,VT at 6 ml/kg,I∶E at 1∶2 and PEEP at 6 cm H2O during ventilation.PErCO2 was maintained at 35-45 mm Hg in both groups.Airway peak pressure (Pp~),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were measured at 5 min after intubation (T1),45 min of pneumoperitoneum (T2),and 15 min after the end of pneumoperitoneum (T3).Arterial blood samples were obtained at T1,T2 and T3 for blood gas analysis.Alveolar-arterial oxygen gradiant (A-aDO2),oxygenation index (PaO2/FiO2),respiratory index (RI) and physiologic dead space fraction (VD/VT) were calculated.The extubation time and development of complications were recorded within 48 h after operation.Results Compared with group Ⅰ,Ppeak and Plat at T2 and Raw at T1,2 were significantly decreased,Cdyn at T2 and PaO2/FiO2 at T1-3 were significantly increased,RI,VD/VT and A-aDO2 were significantly decreased at T1-3,and the incidence of hyoxemia,atelectasis and rales was decreased within 48 h after operation in group Ⅱ (P ＜ 0.05).There was no significant difference in the extubation time between the two groups (P ＞ 0.05).Conclusion Mechanical ventilation with lower tidal volume (6 nl/kg) and PEEP (6 cm H2O) can improve the pulmonary function during laparoscopic surgery in patients with COPD.
