Zhang W P, Zhu S M
Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang, China.
Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang, China.
Acta Anaesthesiol Taiwan. 2016 Mar;54(1):1-5. doi: 10.1016/j.aat.2015.11.001. Epub 2015 Dec 13.
High peak airway pressure (Ppeak) and high end-tidal carbon dioxide tension (PETCO2) are the common problems encountered in the obese patients undergoing gynecological laparoscopy with conventional volume-controlled ventilation. This study was designed to investigate whether volume-controlled inverse ratio ventilation (IRV) with inspiratory to expiratory (I:E) ratio of 2:1 could reduce Ppeak or the plateau pressure (Pplat), improve oxygenation, and alleviate lung injury in patients with normal lungs.
Sixty obese patients undergoing gynecological laparoscopy were enrolled in this study. After tracheal intubation, the patients were randomly divided into the IRV group (n = 30) and control group (n = 30). They were ventilated with an actual tidal volume of 8 mL/kg, respiratory rate of 12 breaths/min, zero positive end-expiratory pressure and I:E of 1:2 or 2:1. Arterial blood samples, hemodynamic parameters, and respiratory mechanics were recorded before and during pneumoperitoneum. The concentrations of tumor necrosis factor-α, and interleukins 6 and 8 in bronchoalveolar lavage fluid were measured immediately before and 60 minutes after onset of CO2 pneumoperitoneum.
IRV significantly increased arterial partial pressure of oxygen, mean airway pressure, and dynamic compliance of respiratory system with concomitant significant decreases in Ppeak and Pplat compared to conventional ventilation with I:E of 1:2 (p < 0.05). Additionally, the levels of tumor necrosis factor-α, and interleukins 6 and 8 were significantly lower than those in control group (p < 0.05).
Volume-controlled IRV not only reduces Ppeak, Pplat, and the release of inflammatory cytokines, but also increases mean airway pressure, and improves oxygenation and dynamic compliance of respiratory system in obese patients undergoing gynecologic laparoscopy without adverse respiratory and hemodynamic effects. It is superior to conventional ratio ventilation in terms of oxygenation, respiratory mechanics and inflammatory cytokine in obese patients undergoing gynecologic laparoscopy.
在肥胖患者接受妇科腹腔镜手术并采用传统容量控制通气时，高峰气道压力（Ppeak）升高和呼气末二氧化碳分压（PETCO2）升高是常见问题。本研究旨在探讨吸气与呼气（I:E）比例为2:1的容量控制反比通气（IRV）是否能降低Ppeak或平台压（Pplat）、改善氧合，并减轻肺功能正常患者的肺损伤。
60例接受妇科腹腔镜手术的肥胖患者纳入本研究。气管插管后，患者被随机分为IRV组（n = 30）和对照组（n = 30）。两组均采用实际潮气量8 mL/kg、呼吸频率12次/分钟、呼气末正压为零，I:E为1:2或2:1进行通气。在气腹前和气腹期间记录动脉血样本、血流动力学参数和呼吸力学指标。在二氧化碳气腹开始前和开始后60分钟立即测量支气管肺泡灌洗液中肿瘤坏死因子-α、白细胞介素6和8的浓度。
与I:E为1:2的传统通气相比，IRV显著提高了动脉血氧分压、平均气道压和呼吸系统动态顺应性，同时Ppeak和Pplat显著降低（p < 0.05）。此外，肿瘤坏死因子-α、白细胞介素6和8的水平显著低于对照组（p < 0.05）。
容量控制IRV不仅能降低Ppeak、Pplat和炎症细胞因子的释放，还能增加平均气道压，改善接受妇科腹腔镜手术肥胖患者的氧合和呼吸系统动态顺应性，且无不良呼吸和血流动力学影响。在接受妇科腹腔镜手术的肥胖患者中，就氧合、呼吸力学和炎症细胞因子而言，IRV优于传统比例通气。
