Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
PLoS One. 2018 Nov 29;13(11):e0207841. doi: 10.1371/journal.pone.0207841. eCollection 2018.
Major laparoscopic pelvic surgery requires steep Trendelenburg position with pneumoperitoneum for a long time. We investigated the effect of Trendelenburg position with pneumoperitoneum on diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery using M-mode sonography. Twenty patients undergoing elective pelviscopic radical hysterectomy were included in this study. Diaphragmatic excursion was measured at the following time points; after sedation, after intubation, 90 minutes after Trendelenburg position with pneumoperitoneum, and after operation with recovery of muscle relaxation. And lung compliance was measured using anesthetic machine under general anesthesia; after the intubation, 90 minutes after Trendelenburg position with pneumoperitoneum and after operation with recovery of muscle relaxation. In order to detect postoperative pulmonary complication, postoperative chest radiography was checked. Static lung compliance, dynamic lung compliance and diaphragmatic excursion were decreased during operation (P < 0.001, respectively). At the end of the operation with recovery of muscle relaxation, reduced diaphragmatic movement was not recovered as its excursion after sedation (P < 0.001). In conclusion, lung compliance was decreased following transiently decreased diaphragmatic excursion during major laparoscopic pelvic surgery.
主要的腹腔镜盆腔手术需要长时间的倾斜特伦德伦伯格体位和气腹。我们使用 M 型超声研究了主要腹腔镜盆腔手术中特伦德伦伯格体位和气腹对膈肌活动度和肺顺应性的影响。这项研究纳入了 20 例行择期腹腔镜根治性子宫切除术的患者。在以下时间点测量膈肌活动度：镇静后、插管后、气腹特伦德伦伯格体位 90 分钟后和肌肉松弛恢复后的手术后。并在全身麻醉下使用麻醉机测量肺顺应性；插管后、气腹特伦德伦伯格体位 90 分钟后和肌肉松弛恢复后的手术后。为了检测术后肺部并发症，术后进行了胸部 X 线检查。在手术过程中，静态肺顺应性、动态肺顺应性和膈肌活动度均降低（P<0.001）。在肌肉松弛恢复后的手术结束时，减少的膈肌运动并没有像镇静后那样恢复其活动度（P<0.001）。总之，在主要的腹腔镜盆腔手术中，肺顺应性随着短暂的膈肌活动度降低而降低。
