Golparvar Mohammad, Mofrad Simaa Zangouei, Mahmoodieh Mohsen, Kalidarei Behrooz
Department of Anesthesia, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2018 May 29;7:89. doi: 10.4103/abr.abr_75_17. eCollection 2018.
Laparoscopic bariatric surgeries in morbid obese patients may be associated with atelectasis, hypercapnia, and hypoxemia, intra and postoperatively. Several strategies are used for the prevention of these consequences. This study aimed to examine the effects of three different recruitment maneuvers comparatively during surgery and the influence of the maneuvers on some cardiopulmonary indices.
In a clinical trial, ninety participants of laparoscopic surgery with body mass index higher than 40 were randomly divided into three equal groups. The first group was subject to 10 cmHO positive end-expiratory pressure (PEEP) during surgery, the second group, after venting the pneumoperitoneum, had 5 deep breaths with a positive pressure of 40 cmHO, and the third group was subject to both. Some pulmonary and hemodynamic parameters were measured every 15 min and compared between three groups.
The average of peak airway pressure, plateau airway pressure, and SpO static and dynamic compliance between the three groups had no meaningful differences ( > 0.05), but PaCOin the second group was statistically higher than the other two groups ( < 0.05).
Multiple deep breaths alone are not as effective as PEEP or PEEP plus MDB in preventing adverse pulmonary effects in laparoscopic bariatric surgeries of morbid obese patients.
病态肥胖患者的腹腔镜减肥手术在术中和术后可能与肺不张、高碳酸血症和低氧血症相关。有几种策略可用于预防这些后果。本研究旨在比较三种不同的肺复张手法在手术期间的效果以及这些手法对一些心肺指标的影响。
在一项临床试验中，90名体重指数高于40的腹腔镜手术参与者被随机分为三组，每组人数相等。第一组在手术期间接受10 cmH₂O的呼气末正压（PEEP），第二组在气腹放气后进行5次40 cmH₂O正压的深呼吸，第三组同时接受这两种处理。每15分钟测量一些肺和血流动力学参数，并在三组之间进行比较。
三组之间的气道峰压、平台气道压以及静态和动态顺应性的平均值没有显著差异（P>0.05），但第二组的PaCO₂在统计学上高于其他两组（P<0.05）。
在病态肥胖患者的腹腔镜减肥手术中，单独多次深呼吸在预防不良肺部影响方面不如PEEP或PEEP加多次深呼吸有效。
