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丁宁静, 余琼. 肥胖患者接受腹腔镜下袖状胃切除术的肺通气策略[J]. 中国临床医学, 2023, 30(5): 840-845. DOI: 10.12025/j.issn.1008-6358.2023.20231089
引用本文: 丁宁静, 余琼. 肥胖患者接受腹腔镜下袖状胃切除术的肺通气策略[J]. 中国临床医学, 2023, 30(5): 840-845. DOI: 10.12025/j.issn.1008-6358.2023.20231089
DING Ning-jing, YU Qiong. Ventilation strategy in obese patients undergoing laparoscopic sleeve gastrectomy[J]. Chinese Journal of Clinical Medicine, 2023, 30(5): 840-845. DOI: 10.12025/j.issn.1008-6358.2023.20231089
Citation: DING Ning-jing, YU Qiong. Ventilation strategy in obese patients undergoing laparoscopic sleeve gastrectomy[J]. Chinese Journal of Clinical Medicine, 2023, 30(5): 840-845. DOI: 10.12025/j.issn.1008-6358.2023.20231089

肥胖患者接受腹腔镜下袖状胃切除术的肺通气策略

Ventilation strategy in obese patients undergoing laparoscopic sleeve gastrectomy

  • 摘要:
    目的 探讨肥胖患者在腹腔镜下袖状胃切除术(laparoscopic sleeve gastrectomy, LSG)中的理想通气策略。
    方法 回顾性收集2012年1月1日至2017年1月31日在复旦大学附属华山医院接受LSG的肥胖患者在DoCare系统中的数据。根据相对于理想体质量(ideal body weight, IBW)的术中平均潮气量(tidal volume, VT)将患者分为3组:低VT组(平均VT<10 mL/kg IBW)、中等VT组(平均VT 10~12 mL/kg IBW)和高VT组(平均VT>12 mL/kg IBW)。比较3组患者基线资料,术中气腹期间的气道峰压(peak airway pressure, Ppeak)、呼气末正压(positive end-expiratory pressure, PEEP)、氧合指数(oxygenation index, OI)、肺动态顺应性(dynamic compliance, Cdyn),以及术后呼吸系统并发症。
    结果 共纳入81例患者,其中97.5%(79/81)采用压力控制通气模式,64.2%(52/81)术中平均VT≥10 mL/kg IBW。3组患者气腹期间通气参数比较显示,与低VT组相比,中等VT组和高VT组Cdyn显著增加(P<0.01);高VT组的Ppeak和OI显著增加(P<0.01)。3组患者PEEP、拔管时间和术后肺部并发症差异无统计学意义。
    结论 与VT<10 mL/kg IBW和VT>12 mL/kg IBW相比,肥胖患者LSG术中接受VT 10~12 mL/kg IBW时的肺顺应性较好,且气道压力没有显著增加,可以作为此类手术的通气策略选择。

     

    Abstract:
    Objective To explore the ideal ventilation strategy for obese patients undergoing laparoscopic sleeve gastrectomy (LSG).
    Methods Data of obese patients undergoing LSG from January 1, 2012 to January 31, 2017 in Huashan Hospital, Fudan University were retrospectively collected from the hospital DoCare system. According to the mean tidal volume (VT) relative to the ideal body weight (IBW), the patients were divided into three groups: low VT group (average VT < 10 mL/kg IBW), medium VT group (average VT 10-12 mL/kg IBW) and high VT group (average VT > 12 mL/kg IBW). The general data, peak airway pressure (Ppeak), positive end-expiratory pressure (PEEP), oxygenation index (OI), pulmonary dynamic compliance (Cdyn) during pneumoperitoneum and postoperative respiratory complications were compared among the three groups.
    Results A total of 81 patients were included, of which 97.5% (79/81) patients were ventilated with pressure-controlled ventilation (PCV) mode and 64.2% (52/81) patients received VT ≥10 mL/kg IBW during pneumoperitoneum. Compared with the low VT group, the Cdyn in the middle VT group and the high VT group increased significantly, and the Ppeak and OI in the high VT group increased significantly (P < 0.01). There was no significant difference in PEEP, extubation time and postoperative pulmonary complications among the three groups.
    Conclusions Compared with VT < 10 mL/kg IBW and VT > 12 mL/kg IBW, obese patients receiving LSG with VT 10-12 mL/kg IBW had better lung compliance and no significant increase in airway pressure, which could be used as a ventilation strategy for this kind of surgery.

     

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