Mäkinen M T, Yli-Hankala A
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Can J Anaesth. 1998 Sep;45(9):865-70. doi: 10.1007/BF03012221.
Side stream spirometry with dynamic compliance displayed as pressure-volume loops, has enabled early detection of CO2 pneumothorax during pneumoperitoneum. We compared dynamic compliance profiles of two laparoscopic procedures with different patient positions.
In 26 patients, scheduled either for laparoscopic fundoplication in a head-up tilt or inguinal herniorrhaphy in a head-down tilt, dynamic compliance was measured with continuous spirometry from anaesthesia induction until skin closure. Control pressure-volume loops were saved in the horizontal position before surgery and compared with succeeding loops in the head-up/head-down tilt before pneumoperitoneum, during pneumoperitoneum in the horizontal and the tilt position, after evacuation of pneumoperitoneum in the tilt and finally in the horizontal position.
Pneumoperitoneum reduced compliance in both groups by 35% (P < 0.01). Head-down tilt decreased compliance by 12% before and during pneumoperitoneum (P < 0.01). Head-up tilt increased compliance by 4% before pneumoperitoneum (P < 0.05), but during pneumoperitoneum it had no effect. After evacuation of pneumoperitoneum compliance returned immediately to control in head-up tilt, but remained reduced in head-down tilt and was not at control after adopting horizontal position (P < 0.05). Difference between the groups was significant (P < 0.01) in the head-up/head-down tilt before, during and immediately after pneumoperitoneum.
Both pneumoperitoneum and head-up and head-down positions had characteristic effects on dynamic compliance. Simultaneous display of sequential pressure-volume loops enabled immediate detection of changes in respiratory mechanics.
采用侧流式肺量计，将动态顺应性以压力-容积环的形式显示，能够在气腹期间早期检测出二氧化碳气胸。我们比较了两种不同患者体位的腹腔镜手术的动态顺应性曲线。
选取26例患者，分别计划行头高位腹腔镜胃底折叠术或头低位腹股沟疝修补术，从麻醉诱导直至皮肤缝合，通过连续肺量计测量动态顺应性。术前将对照压力-容积环保存在水平位，与气腹前、气腹期间水平位和倾斜位、气腹排出后倾斜位以及最终水平位的头高位/头低位后续环进行比较。
气腹使两组的顺应性均降低35%（P<0.01）。头低位在气腹前和气腹期间使顺应性降低12%（P<0.01）。头高位在气腹前使顺应性增加4%（P<0.05），但在气腹期间无影响。气腹排出后，头高位的顺应性立即恢复至对照水平，但头低位仍降低，且恢复至水平位后仍未达到对照水平（P<0.05）。气腹前、气腹期间和气腹排出后立即进行的头高位/头低位两组间差异显著（P<0.01）。
气腹以及头高位和头低位对动态顺应性均有特征性影响。连续压力-容积环的同步显示能够立即检测呼吸力学的变化。
