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The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery.腹腔镜手术中气腹和头低脚高位对呼吸力学的影响。
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2
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Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia.异氟烷、七氟烷和地氟烷麻醉期间的肺力学
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Influence of the patient positioning on respiratory mechanics during pneumoperitoneum.患者体位对气腹期间呼吸力学的影响。
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七氟醚与异丙酚-瑞芬太尼麻醉用于腹腔镜结肠切除术的呼吸力学比较。

Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy.

机构信息

Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea.

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Korean J Anesthesiol. 2014 Feb;66(2):131-5. doi: 10.4097/kjae.2014.66.2.131. Epub 2014 Feb 28.

DOI:10.4097/kjae.2014.66.2.131
PMID:24624271
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3948440/
Abstract

BACKGROUND

The creation of pneumoperitoneum and Trendelenburg positioning during laparoscopic surgery are associated with respiratory changes. We aimed to compare respiratory mechanics while using intravenous propofol and remifentanil vs. sevoflurane during laparoscopic colectomy.

METHODS

SIXTY PATIENTS UNDERGOING LAPAROSCOPIC COLECTOMY WERE RANDOMLY ALLOCATED TO ONE OF THE TWO GROUPS: group PR (propofol-remifentanil group; n = 30), and group S (sevoflurane group; n = 30). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and respiratory resistance (Rrs) values at five different time points: 5 minutes after induction of anesthesia (supine position, T1), 3 minutes after pneumoperitoneum (lithotomy position, T2), 3 minutes after pneumoperitoneum while in the lithotomy-Trendelenburg position (T3), 30 minutes after pneumoperitoneum (T4), and 3 minutes after deflation of pneumoperitoneum (T5).

RESULTS

In both groups, there were significant increases in PIP and Rrs while Cdyn decreased at times T2, T3, and T4 compared to T1 (P < 0.001). The Rrs of group PR for T2, T3, and T4 were significantly higher than those measured in group S for the corresponding time points (P < 0.05).

CONCLUSIONS

Respiratory mechanics can be adversely affected during laparoscopic colectomy. Respiratory resistance was significantly higher during propofol-remifentanil anesthesia than sevoflurane anesthesia.

摘要

背景

腹腔镜手术中创建气腹和头低脚高位与呼吸变化有关。我们旨在比较腹腔镜结肠切除术期间使用异丙酚和瑞芬太尼与七氟醚时的呼吸力学。

方法

60 例行腹腔镜结肠切除术的患者随机分为两组：PR 组（异丙酚-瑞芬太尼组；n = 30）和 S 组（七氟醚组；n = 30）。在五个不同时间点测量峰吸气压（PIP）、动态肺顺应性（Cdyn）和呼吸阻力（Rrs）值：麻醉诱导后 5 分钟（仰卧位，T1）、气腹后 3 分钟（截石位，T2）、气腹后 3 分钟同时处于截石位-头低脚高位（T3）、气腹后 30 分钟（T4）和放气后 3 分钟（T5）。

结果

两组在 T2、T3 和 T4 时 PIP 和 Rrs 均显著升高，而 Cdyn 与 T1 相比降低（P < 0.001）。与 S 组相比，PR 组在 T2、T3 和 T4 时的 Rrs 显著更高（P < 0.05）。

结论

腹腔镜结肠切除术中呼吸力学可能受到不利影响。异丙酚-瑞芬太尼麻醉时呼吸阻力明显高于七氟醚麻醉。