小潮气量通气对腹腔镜下肝部分切除术患者循环功能的影响

高宪; 黄艰; 杨贞; 朱圆; 向伦理; 鲁开智; 甯交琳

doi:10.16016/j.1000-5404.201906205

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小潮气量通气对腹腔镜下肝部分切除术患者循环功能的影响

临床医学 | 更新时间：2026-01-09

- 小潮气量通气对腹腔镜下肝部分切除术患者循环功能的影响
- Effects of low tidal volume ventilation on circulatory function in patients undergoing laparoscopic liver resection
- 第三军医大学学报 2019年41卷第21期页码：2114-2119
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
  
  [甯交琳，E-mail: 460439856@qq.comNING Jiaolin, E-mail: 460439856@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201906205
  中图分类号： R331.3;R614;R657.3
- 收稿：2019-06-29，
  
  修回：2019-08-08，
  
  纸质出版：2019-11-15
- 稿件说明：
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高宪, 黄艰, 杨贞, 等. 小潮气量通气对腹腔镜下肝部分切除术患者循环功能的影响[J]. 第三军医大学学报, 2019,41(21):2114-2119.

Xian GAO, Jian HUANG, Zhen YANG, et al. Effects of low tidal volume ventilation on circulatory function in patients undergoing laparoscopic liver resection[J]. Journal of Third Military Medical University, 2019, 41(21): 2114-2119.
高宪, 黄艰, 杨贞, 等. 小潮气量通气对腹腔镜下肝部分切除术患者循环功能的影响[J]. 第三军医大学学报, 2019,41(21):2114-2119. DOI： 10.16016/j.1000-5404.201906205.

Xian GAO, Jian HUANG, Zhen YANG, et al. Effects of low tidal volume ventilation on circulatory function in patients undergoing laparoscopic liver resection[J]. Journal of Third Military Medical University, 2019, 41(21): 2114-2119. DOI： 10.16016/j.1000-5404.201906205.

摘要

目的

比较小潮气量通气和常规潮气量通气对腹腔镜下肝脏切除手术过程中循环功能的影响。

方法

纳入2017年7-12月于我院计划接受腹腔镜下肝部分切除术患者22例，按随机数字表法分为2组(

=11)，常规潮气量组(conventional tidal volume，CTV)和小潮气量组(low tidal volume，LTV)采取相同麻醉诱导、维持方案。CTV组患者接受常规潮气量通气[10~12 mL/kg(理想体质量)、无呼气末正压通气(positive end expiratory pressure，PEEP)、无手法复张

]

，LTV组患者接受小潮气量通气[6~8 mL/kg(理想体质

量)、无PEEP、每30 min采用手法复张1次，每次将气道压维持在30 cmH

O，持续30 s，3个循环

]

。比较两组病例不同时相点每博量变异度(stroke volume variance

SVV)、中心静脉压(central venous pressure

CVP)、心脏指数(cardiac index

CI)、外周血管阻力指数(systemic vascular resistance index

SVRI)、平均动脉压(mean artery blood pressure

MAP)、心率(heart rate

HR)等术中循环指标、术中血管活性药物的使用量以及术后外科医师对术中麻醉循环管理评分。

结果

① LTV组需要输注去甲肾上腺素维持血压的患者少于CTV组(1

8例，

0.05)；②在气腹建立后，CTV(22.6±6.2

13.3±3.6，

0.01)和LTV(17.2±6.4

13.0±3.9，

0.05)组患者SVV均明显高于气腹建立前水平；人工气腹建立期间，LTV组SVV均低于CTV组，人工气腹建立后第15 min(T

:17.2±6.4

22.6±6.2，

0.05)及第30 min(T

:17.1±4.0

22.1±5.8，

0.05)，两组间比较差异具有统计学意义；③在气腹建立后即刻，CTV(2.7±1.6

5.6±2.0 cmH

O，

0.05)和LTV组患者CVP均降低，在整个人工气腹过程中均低于气腹建立前水平，自身前后对照比较无统计学差异；④术后外科医师对术中麻醉循环管理评分LTV组明显高于CTV组(3.7±0.8

3.1±0.5，

0.05)。

结论

与常规潮气量通气比较，小潮气量通气可减低人工气腹对腹腔镜肝部分切除术患者术中循环功能的影响，有利于循环稳定、便于外科医师手术操作。

Abstract

Objective

To compare the effect of low tidal volume (LTV) ventilation versus conventional tidal volume (CTV) ventilation on circulatory function in patients undergoing laparoscopic liver resection (LLR).

Methods

A total of 22 patients who underwent selective LLR in our hospital from July to December 2017 were enrolled into this study. They were prospectively randomized to CTV group (

=11) and LTV group (

=11). They all received same anesthesia induction and maintenance

and those of the CTV group underwent conventional mechanical ventilation (tidal volume: 10~12 mL/kg) without positive end expiratory pressure (PEEP) or recruitment maneuver

while those of the LTV group were given

mechanical ventilation with lower tidal volume (6~8 mL/kg) along with recruitment maneuver (once/30 min) but no PEEP during operation

with the airway pressure being maintained at 30 cmH

O for 30 s at a time for 3 cycles. The intraoperative circulation indexes including stroke volume variance (SVV)

central venous pressure (CVP)

cardiac index (CI)

systemic vascular resistance index (SVRI)

mean artery pressure (MAP)

heart rate (HR)

doses of vasopressor usage

and score of intraoperative anesthesia circulation management made by surgeons postoperatively were compared between the 2 groups.

Results

① There were less patients receiving norepinephrine to maintain MAP in the CTV group than the LTV group (1

8 cases

0.05). ②After the establishment of pneumoperitoneum

SVV was significantly elevated in the CTV group (22.6±6.2

13.3±3.6

0.01) and the LTV group (17.2±6.4

13.0±3.9

0.05) when compared with that before establishment. SVV was lower in the LTV group than the CTV group during the phase of establishment

with statistical differences at 15 (17.2±6.4

22.6±6.2

0.05) and 30 min (17.1±4.0

22.1±5.8

0.05) after the establishment of pneumoperitoneum. ③ CVP was decreased in the LTV group than the CTV group (2.7±1.6

5.6±2.0 cmH

O) immediately after the establishment of pneumoperitoneum when compared with baseline

though without significant difference. ④ The score of intraoperative anesthesia circulation management was notably higher in the LTV group than the CTV group (3.7±0.8

3.1±0.5

0.05).

Conclusion

LTV ventilation reduces the adverse effects of pneumoperitoneum on hemodynamics in the patients undergoing LLR when compared with CTV ventilation

and is facilitated to stabilization of hemodynamics and better operating conditions for surgeons.

关键词

Keywords

references

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