Griva Panagiota, Talliou Christina, Rougeris Loizos, Samara Dimitra, Panagouli Konstantina, Varvarousi Giolanda, Papa Maria, Kathopoulis Nikolaos, Chantziara Vasiliki, Rovina Nikoletta
Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece.
Department of Anaesthesiology, Rea Maternity Hospital, 17564 Athens, Greece.
J Pers Med. 2024 Apr 25;14(5):451. doi: 10.3390/jpm14050451.
BACKGROUND/OBJECTIVES: This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery.
A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8).
Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmHO, IQR: 9.75 mL/cmHO), high Body Mass Index 30.32 kg/m (IQR: 1.05 kg/m), and high initial plateau airway pressure (16.5 cmHO, IQR: 0.75 cmHO).
Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.
背景/目的：本研究旨在探讨肺泡复张手法能否在腹腔镜妇科手术后将肺顺应性恢复至初始值这一假设。
共纳入31例行腹腔镜妇科手术的患者。采用保护性机械通气，所有患者均行桡动脉置管。气腹解除后10分钟应用肺泡复张手法（递增和递减呼气末正压）。在八个不同时间点记录呼吸力学和血气结果：麻醉诱导后（T1）、截石位时（T2）、头低脚高位时（T3）、二氧化碳气腹后10分钟和90分钟（T4和T5）、仰卧位时（T6）、气腹解除后（T7）以及手术结束时肺泡复张手法后10分钟（T8）。
与基线相比，气腹和头低脚高位导致顺应性下降15个单位（T7与T1相比；<0.05）。肺泡复张手法后，顺应性较T1时顺应性平均值增加了17.5%（T8与T1相比；<0.05）。复张手法在初始顺应性低（41.5 mL/cmH₂O，四分位间距：9.75 mL/cmH₂O）、体重指数高30.32 kg/m²（四分位间距：1.05 kg/m²）和初始平台气道压高（16.5 cmH₂O，四分位间距：0.75 cmH₂O）的患者中取得了良好效果。
腹腔镜妇科手术后肺顺应性未恢复至初始值。然而，气腹解除后，肺泡复张手法有益，因为它可改善顺应性和气体交换。
