Atashkhoei Simin, Yavari Negin, Zarrintan Mahsa, Bilejani Eisa, Zarrintan Sina
Department of Anesthesia, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2020 Apr 18;10(2):e100075. doi: 10.5812/aapm.100075. eCollection 2020 Apr.
During gynecologic laparoscopy, pneumoperitoneum, and the position of the patient's head can lead to pathophysiologic changes in cardiovascular and respiratory systems, complicating the management of anesthesia in these patients. One of the strategies for improving the respiratory status of patients undergoing laparoscopy is the use of Positive End-Expiratory Pressure (PEEP).
This study aimed to evaluate the effect of different levels of PEEP on the respiratory status of patients undergoing gynecologic laparoscopy.
In this clinical trial, 60 patients with ASA I were randomly assigned to three groups to control anesthesia: ZEEP (PEEP 0 cmHO; 20 cases), PEEP (PEEP 5 cmHO; 20 cases), and PEEP (PEEP 10 cmHO; 20 cases). Respiratory and hemodynamic variables of patients were compared before general anesthetic induction and immediately after CO insufflation at intervals of 5, 10, 20, 30, and 60 min and the end of the operation in the three study groups.
The PEEP application improved pH, PaCO, and PaO levels at the end of pneumoperitoneum compared to baseline when compared with the non-use of PEEP (ZEEP group). Also, the frequency of dysrhythmia in the use of PEEP in controlled ventilation was significantly lower in patients with PEEP (P < 0.05). The application of PEEP resulted in similar effects to PEEP in the levels of respiratory variables.
The PEEP application is associated with improved arterial blood gas in patients with gynecologic laparoscopy. The use of PEEP has a greater effect on the improvement of respiratory parameters and complications of pneumoperitoneum.
在妇科腹腔镜手术中，气腹和患者头部位置可导致心血管和呼吸系统发生病理生理变化，使这些患者的麻醉管理复杂化。改善腹腔镜手术患者呼吸状态的策略之一是使用呼气末正压通气（PEEP）。
本研究旨在评估不同水平的PEEP对妇科腹腔镜手术患者呼吸状态的影响。
在这项临床试验中，60例ASA I级患者被随机分为三组进行麻醉控制：零PEEP组（PEEP 0 cmH₂O；20例）、低PEEP组（PEEP 5 cmH₂O；20例）和高PEEP组（PEEP 10 cmH₂O；20例）。比较三组研究对象在全身麻醉诱导前、二氧化碳气腹后5、10、20、30和60分钟以及手术结束时的呼吸和血流动力学变量。
与未使用PEEP（零PEEP组）相比，气腹结束时应用PEEP可改善pH值、动脉血二氧化碳分压（PaCO₂）和动脉血氧分压（PaO₂）水平。此外，在控制通气中使用PEEP时，低PEEP组和高PEEP组患者的心律失常发生率显著降低（P<0.05）。低PEEP组和高PEEP组应用PEEP后呼吸变量水平的效果相似。
在妇科腹腔镜手术患者中应用PEEP可改善动脉血气。使用PEEP对改善呼吸参数和气腹并发症有更大作用。
