Fahy B G, Barnas G M, Flowers J L, Jacobs S C, Plotkin J S, Delaney P A
Department of Anesthesiology, University of Maryland, Baltimore 21201-1595, USA.
J Clin Anesth. 1998 Mar;10(2):103-8. doi: 10.1016/s0952-8180(97)00251-1.
To test whether split torso positioning, abdominal insufflation, and other procedures performed during laparoscopic nephrectomy would affect mechanical impedances to inflation [i.e., elastance (E) and resistance (R) of the total respiratory system (Ers, and Rrs), lungs (EL and RL), and chest wall (Ecw and Rcw)] differently from previously studied laparoscopic procedures.
Unblinded study, each patient serving as own control.
University hospital.
12 ASA physical status I and II patients scheduled for laparoscopic donor nephrectomy, all without cardiopulmonary disease.
Patients were anesthetized and paralyzed, tracheally intubated and mechanically ventilated at 10, 20, and 30 breaths/minute and at tidal volumes of 250, 500, and 800 ml. Measurements were made in the following positions: supine, split torso, abdominal insufflation (Pab = 15 mmHg), and supine after deflation.
Airway flow and pressure and esophageal pressure were measured. Discrete Fourier transformation was used to calculate E and R. These were analyzed with repeated measures, linear multiple regression with accepted level of significance at p < 0.05. Ers, Ecw, and Rcw increased (p < 0.05) while EL decreased (p < 0.05) when patients changed from supine to split torso. During Pab = 15 mmHg, Ers, Ecw, and Rcw increased further and Rrs and RL increased (p < 0.05). Following abdominal deflation, Ecw and Ers remained elevated (p < 0.05). The changes in Ecw caused by laparoscopy and surgery were greater than we have previously measured in other laparoscopic procedures, while the changes in EL were less.
Laparoscopic nephrectomy affects lung and chest wall mechanical properties differently from other laparoscopic procedures. This finding could be due to the split torso positioning, and the effects of abdominal swelling on the chest wall caused by administration of more perioperative fluids with laparoscopic nephrectomy.
测试腹腔镜肾切除术期间采用的躯干劈开体位、腹腔充气及其他操作对充气机械阻抗[即整个呼吸系统（Ers和Rrs）、肺（EL和RL）以及胸壁（Ecw和Rcw）的弹性（E）和阻力（R）]的影响是否与之前研究的腹腔镜手术不同。
非盲法研究，每位患者自身作为对照。
大学医院。
12例计划接受腹腔镜供体肾切除术的美国麻醉医师协会（ASA）身体状况I级和II级患者，均无心肺疾病。
患者麻醉后肌肉松弛，气管插管并分别以每分钟10次、20次和30次呼吸频率以及250毫升、500毫升和800毫升潮气量进行机械通气。在以下体位进行测量：仰卧位、躯干劈开位、腹腔充气（Pab = 15 mmHg）以及放气后的仰卧位。
测量气道流量、压力和食管压力。采用离散傅里叶变换计算E和R。通过重复测量、线性多元回归分析这些指标，显著性水平设定为p < 0.05。当患者从仰卧位变为躯干劈开位时Ers、Ecw和Rcw升高（p < 0.05），而EL降低（p < 0.05）。在Pab = 15 mmHg时，Ers、Ecw和Rcw进一步升高，Rrs和RL升高（p < 0.05）。腹腔放气后，Ecw和Ers仍保持升高（p < 0.05）。腹腔镜检查和手术引起的Ecw变化大于我们之前在其他腹腔镜手术中所测量的，而EL的变化较小。
腹腔镜肾切除术对肺和胸壁机械特性的影响与其他腹腔镜手术不同。这一发现可能归因于躯干劈开体位以及腹腔镜肾切除术围手术期输入更多液体导致腹部肿胀对胸壁产生的影响。
