【原】【罂粟摘要】复吸手法对腹腔镜胆囊切除术全麻患者静态肺顺应性的影响:一项单中心前瞻性临床干预研究

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复吸手法对腹腔镜胆囊切除术全麻患者静态肺顺应性的影响:一项单中心前瞻性临床干预研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：王婷婷  编辑：王婷婷  审校：曹莹

背景和目的:本研究的目的是探讨在腹腔镜胆囊切除术患者中，肺泡恢复操作(RM)是否能显著增加静态肺顺应性(Cstat)和改善气体交换。

材料与方法:进行临床前瞻性干预研究。根据体重指数(BMI)将患者分为正常体重组(I组)和肥胖前期及肥胖I级组(II组)。监测肺力学(Cstat、动态依从性- cdin、峰值压强- ppeak、平台压强- pplat、驱动压强- dp)及6个时间点的血液动力学变化(心率- hr、平均动脉压强- map)。T1(麻醉诱导)、T2(气腹形成)、T3(正压5 cm H2O的RM)、T4(正压7 cm H2O的RM)、T5(消肿)、T6(结束时RM)。RM是通过在相同的吸气呼气比(I/E = 1:1)下将峰值压力增加+5 cm的H2O，并施加5和7cm的H2O的PEEP来进行的。

结果: 96例患者中，ⅰ组33例，ⅱ组63例。在所有三个rm之后，Cstat值都增加了。在每个时间点，组I的Cstat值均高于组II。在第二次和第三次放射治疗后，第二组观察到Cstat的较高增加。Cstat值在手术结束时高于麻醉诱导后的值。RM导致两组PaO2显著升高，HR和MAP均无变化。

结论: 在腹腔镜胆囊切除术中，应用RM可使Cstat显著增加，气体交换改善。麻醉期间预防肺不张应在麻醉诱导后立即开始，使用保护性机械通气和RM。

原始文献来源：Anđelić N, Uvelin A, Stokić E, et al. The Effect of Recruitment Maneuver on Static Lung Compliance in Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy: A Single-Centre Prospective Clinical Intervention Study. Medicina (Kaunas). 2024;60(4):666. Published 2024 Apr 19. doi:10.3390/medicina60040666

The Effect of Recruitment Maneuver on Static Lung Compliance in Patients Undergoing General Anesthesia for Laparoscopic Cholecystectomy: A Single-Centre Prospective Clinical Intervention Study

Background and Objectives: The aim of this study was to examine whether the use of an alveolar recruitment maneuver (RM) leads to a significant increase in static lung compliance (Cstat) and an improvement in gas exchange in patients undergoing laparoscopic cholecystectomy. 

Material and Methods: A clinical prospective intervention study was conducted. Patients were divided into two groups according to their body mass index (BMI): normal-weight (group I) and pre-obese and obese grade I (group II). Lung mechanics were monitored (Cstat, dynamic compliance-Cdin, peak pressure-Ppeak, plateau pressure-Pplat, driving pressure-DP) alongside gas exchange, and hemodynamic changes (heart rate-HR, mean arterial pressure-MAP) at six time points: T1 (induction of anesthesia), T2 (formation of pneumoperitoneum), T3 (RM with a PEEP of 5 cm H2O), T4 (RM with a PEEP of 7 cm H2O), T5 (desufflation), and T6 (RM at the end). The RM was performed by increasing the peak pressure by +5 cm of H2O at an equal inspiration-to-expiration ratio (I/E = 1:1) and applying a PEEP of 5 and 7 cm of H2O. Results: Out of 96 patients, 33 belonged to group I and 63 to group II. An increase in Cstat values occurred after all three RMs. At each time point, the Cstat value was measured higher in group I than in group II. A higher increase in Cstat was observed in group II after the second and third RM. Cstat values were higher at the end of the surgical procedure compared to values after the induction of anesthesia. The RM led to a significant increase in PaO2 in both groups without changes in HR or MAP. 

Conclusions:During laparoscopic cholecystectomy, the application of RM leads to a significant increase in Cstat and an improvement in gas exchange. The prevention of atelectasis during anesthesia should be initiated immediately after the induction of anesthesia, using protective mechanical ventilation and RM.

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