Tafer N, Nouette-Gaulain K, Richebé Ph, Rozé H, Lafargue M, Janvier G
Service d'anesthésie-réanimation II, CHU de Bordeaux, groupe hospitalier Sud, avenue de Magellan, Pessac cedex, France.
Ann Fr Anesth Reanim. 2009 Feb;28(2):130-4. doi: 10.1016/j.annfar.2008.12.022. Epub 2009 Feb 18.
To evaluate recruitment manoeuvre (RM) efficiency associated with a 10 cmH(2)O positive end expiratory pressure (PEEP) on respiratory mechanic estimated by lung compliance (Ctp) and PEEP to ZEEP expiratory volume delta (Delta VTE) during laparoscopic bariatric surgery in patients with morbid obesity.
Prospective randomized study.
Twenty-six obese patients (BMI>40 kg/m(2)) undergoing laparoscopic bariatric surgery. The recruitment group received an RM followed by a 10 cmH(2)O PEP versus only 10 cmH(2)O PEP in the control group. Ctp was measured during the intervention and functional residual capacity (FRC) was estimated measuring Delta VTE during a PEP to ZEP manoeuvre. Mann and Whitney tests as well as a t-test were used (significance p<0.05).
In the RM group, a significant improvement of 52+/-14 ml/cmH(2)O was noted versus a 36+/-10 ml/cmH(2)O in the PEP group (p=0,004). This improvement was transitory and no statistically significant Delta VTE difference was noted between the groups at the end of the intervention (360 [90-770]ml [MRA] and 310 [190-450]ml [PEP]).
In patients with morbid obesity undergoing laparoscopic bariatric surgery, an RM conducted prior the pneumoperitoneum temporarily improves lung mechanics but without any change of the end expiratory lung volume at the end of the surgery in comparison with PEP alone. The RM was well tolerated.
评估在病态肥胖患者的腹腔镜减肥手术中，与10 cmH₂O呼气末正压通气（PEEP）相关的肺复张手法（RM）对肺顺应性（Ctp）和PEEP至零呼气末正压呼气末容积差值（ΔVTE）所估计的呼吸力学的效率。
前瞻性随机研究。
26例接受腹腔镜减肥手术的肥胖患者（BMI>40 kg/m²）。肺复张组先进行肺复张手法，然后给予10 cmH₂O的PEEP，而对照组仅给予10 cmH₂O的PEEP。在干预期间测量Ctp，并在PEEP至零呼气末正压的操作过程中通过测量ΔVTE来估计功能残气量（FRC）。使用曼恩-惠特尼检验以及t检验（显著性p<0.05）。
在肺复张组中，观察到显著改善，为52±14 ml/cmH₂O，而PEEP组为36±10 ml/cmH₂O（p = 0.004）。这种改善是暂时的，在干预结束时两组之间未观察到统计学上显著的ΔVTE差异（360 [90 - 770]ml [肺复张组]和310 [190 - 450]ml [PEEP组]）。
在接受腹腔镜减肥手术的病态肥胖患者中，气腹前进行的肺复张手法可暂时改善肺力学，但与单独使用PEEP相比，手术结束时呼气末肺容积无任何变化。肺复张手法耐受性良好。
