Laparoscopic Surgery Position Change On The Influence Of The Patients With Respiratory Function

Objectives:Laparoscopic surgery position change on the influence of the patients with respiratory function as early as in1901, a man named GeorgKelling German surgeon with a piece of cystoscopy canine abdominal cavity, and the inspection for laparoscopy, which opened the history of laparoscopic application. Although the early laparoscopic for disease diagnosis, but a laparoscopic in medical applications of the first. The first and in laparoscopic surgery is general surgery doctor Fervers, in1933he reported in laparoscopy use biopsy device and burning method release internal adhesion. In1976, Germany will be for the first time for cryptorchidism patients laparoscopic diagnosis of positioning, and opened the prelude of laparoscopic surgical disease. In1979, another foreign doctors Wickham completed the first case of laparoscopic ureteral cut stone art, but due to the limitation of surgical instruments, make the development of laparoscopic then entered into stagnation. With the improvement of medical devices and the doctor to raise the level of experience, most urinary surgery all can do laparoscopic surgery completed, research shows that, after laparoscopic surgery operation effect and to open surgery, and there was no significant difference between groups of patients from the damage degree and postoperative recovery time is superior to open surgery, laparoscopic surgery has become the development trend of the future of surgery.Laparoscopic urological surgery has small trauma, stress reaction light, postoperative rehabilitation fast, but the operation time is long, the special position, the influence of the artificial pneumoperitoneum on breathing, circulation and other physiological function influence is far more than open serious. Laparoscopic urology along with the increasing popularity of technology, operation mode and operation position innovation, people for laparoscopic surgery patients breathing, circulation function to the ill effects of gradually began to pay attention to. Recumbent position and lateral position two position in the comparison of the clinical use frequently, the two position at home and abroad to respiratory function of the study on the impact of deeper strongly suggest that general anesthesia descending laparoscopic surgery for breathing, circulation have greater influence. Along with the prone position laparoscopic surgery the emergence of the position, the prone position laparoscopic surgery on respiratory function of the impact is not very understanding. This study through the research on prone position or lateral position of laparoscopic surgery patients, through the collection of intraoperative postoperative patients with heart rate, blood pressure, breathing the carbon dioxide, airway peak pressure and other material to study two kinds of body position on respiratory function of the difference between the influence, and find out the corresponding countermeasures to reduce its influence, and for intraoperative anesthesia monitoring provide data support.Methods:The experimental research object for hebei medical university second hospital uropoiesis surgical hospital patients, patients prone position in11cases,6cases of male, female5cases). Age30-61y, an average of46.63±10.88y. Body mass index19～29kg/m2, an average of24.54±3.47kg/m2. Lateral position patients in14cases, male8cases,6cases of female; Age24～63y, an average of50.21±10.02y; Body mass index and～29kg/m2, an average of24.28±2.64kg/m2. Patients with preoperative perfect relevant inspection, no obvious cardiopulmonary function abnormalities, no particular previous medical history, ASA level Ⅰ or Ⅱ grade. After general anesthesia induced by mouth in strengthening the endotracheal tube, line intermittent positive pressure ventilation mode control breath, tidal volume (VT)8～10ml/kg, respiratory frequency12/min, suction call ratio1:2. Oxygen flow2.0L/min. Vein by trace infusion pump infusion red fentanyl0.1-0.4u g/kg/min propofol2-6mg/kg/min or by inhalation anesthesia add muscle loose medicine to maintain. Intraoperative anesthetic depth according to the electrical double frequency index maintained at45～between55. In patients respectively after anesthesia recumbent position, a change of position after10min, pneumoperitoneum after10min, pneumoperitoneum30min, pneumoperitoneum1h record anesthesia on the airway PEAK pressure (PEAK) and call the co2partial pressure (PETCO2). Application SPSS13.0statistical software for data processing, within the group compares the matching t test, group is compared between the single factor analysis of variance. To evaluate in laparoscopic surgery in these two kinds of body position on the influence of respiratory function.Results:1Different time between the airway peak pressure there is a difference, F=396.37, P<0.05; Two kinds of body position on the influence of the airway peak pressure there is a difference, F=4.453, P=0.046<0.05.2Different time of the call between co2partial pressure there is a difference, F=62.54, P<0.05; Two position at the end of the call for co2partial pressure influence does not exist differences, F=1.599, P=0.2190.05.3All patients in the postoperative pulmonary complications all did not appear.Conclusion:1Different position through the airway of oppression and chest oppression will lead to different levels in patients with airway peak pressure increases level is different, this will be to the patient’s ventilation function different impact. Compared with lateral position and prone position to the patient’s airway and belly much greater oppression, which lead to the patients with ventilation function influence even more significant.2Because the operation is the intermittent positive pressure ventilation mode control breathing, which can make patients of tidal volume in the airway peak pressure decreased, and pulmonary ventilation function and the impacts of gas partial pressure difference, gas solubility and decomposition and the quantity of the film thickness of the breath. And prone position and lateral position of these two kinds of body position changes on patients with ventilation function influence has nothing to do, that makes two different position at the end of the call to the influence of the carbon dioxide partial pressure difference does not exist. And all the patients in the postoperative complications were not appear lung disease, also can indirectly shows two position to patients postoperative lung function and the impact of the patients with pulmonary function recovery does not exist difference. The prone position promotion provide breathing aspect evidence to support.