| Purpose: To investigate the effect of ventilation mode on the ventilation dynamics and the oxygenation of lung tissue in patients with healthy gynecological laparoscopic surgery during the period of CO2 pneumoperitoneum,conventional ventilation mode and proportional ventilation(1:1)combined with positive end expiratory pressure(5cm H2O)influences.For gynecological laparoscopic surgery,and even other surgical laparoscopic surgery to establish the appropriate ventilation mode to provide the basis.Methods: 60 patients with ASA grade I~II,aged 36~64 years and BMI<30kg/cm2 were enrolled in the study.The patients were expected to have gynecological laparoscopic surgery for more than 1 hour.(ECG),pulse oximetry(SPO2),noninvasive blood pressure(at 3-min interval),anesthesia depth BIS,and ulnar nerve stimulation(TOF)monitoring were performed on the patients after admission.After the establishment of intravenous access to the patient,given the patient tropisetron 5mg,sufentanil 5ug slow intravenous injection of analgesic,followed by radial artery catheterization.Anesthesia induction: all patients with conventional mask oxygen to nitrogen,according to the patient to adjust the weight of intravenous anesthesia induction,given midazolam 0.05 mg / kg,sufentanil 0.5ug / kg,cisatriptan 0.15 mg / kg,Propofol 1~1.5mg / kg,assisted ventilation for about 5min after tracheal intubation Link Datex-ohmeda anesthesia machine for mechanical ventilation while monitoring theend-expiratory carbon dioxide partial pressure(PETCO2).Anesthesia maintenance: the use of propofol,remifentanil intravenous anesthesia maintenance,regulation of trace pump cisatracaine 0.08~0.10 mg /(kg·h),propofol 2~6mg/(kg·h)Remifentanil 0.1~0.3ug/(kg·h)to maintain hemodynamic stability,so that blood pressure,heart rate fluctuations in 20%,intraoperative anesthesia depth BIS value maintained at 40~60,ulnar nerve four string stimulation(TOF)<25%,30 min before the end of surgery to disable muscle relaxants.According to the random number table,the patients were randomly divided into group A(20 cases,control group),group B(20 cases,1:1 group)and group C(20 cases,1:1 + PEEP5 cm H2O)Group,the three groups were used to control the ventilation capacity,intubation after the three groups were conventional mechanical ventilation(suction ratio of 1:2,positive end expiratory pressure 0);CO2 pneumoperitoneum immediately after the establishment of respiratory parameters: A group(I:E)1:1;Group B: Absorbency ratio(I:E)1:1 + Positive end expiratory pressure(PEEP)5cm H20.The end-expiratory carbon dioxide partial pressure(PETCO2)was maintained at 35~45 mm Hg by adjusting tidal volume and respiratory rate during mechanical ventilation.Intraoperative artificial CO2 pneumoperitoneum pressure of not more than 14 mm Hg,patients take truncated stone position,head low hip high 30°after the end of surgery to take the level.The hemodynamic parameters were recorded at 10 min(T0),25 min after pneumoperitoneum(T1),30 min after pneumoperitoneum(T2)and 1 h(T3)after pneumoperitoneum,respectively.(T0),15 minutes after pneumoperitoneum(T1),30 minutes after pneumoperitoneum(T2),and 30 minutes after pneumoperitoneum(T2),and 30 minutes after pneumoperitoneum(T2)(PACU)in patients with postoperative anesthesia recovery room(PACU).The patients were followed up for 5 hours after pneumoperitoneum(P <0.05).Follow-up to observe whether the nausea and vomiting,abdominal distension,postoperative shoulder pain and other complications.(Ppeak),mean airway pressure(Pmean),respiratory rate(RR),PH,Pa O2,Pa CO2;secondary observation: intraoperative monitoring of mean blood pressure(MAP)Heart rate(HR),pulse oximetry,electrocardiogram,postoperative PACU time,postoperativecomplications and postoperative hospital stay.Results: 1.The comparison of the general data of the three groups patients.There were no significant differences in age,body mass index,anesthesia time,operation time,pneumoperitoneum time,intraoperative infusion volume and urine out put of the three groups(P>0.05).2.The three groups of patients were compared to the hemodynamics of different time points.There was a significant difference between group A and group B(P=0.004),and HR in group B was lower than that in group A(P<0.05),and there was no significant difference between group A and group B There was no significant difference between group A and group C,group B and group C(P=0.273)at T2 time.There was no statistically significant difference in HR between T0,T1 and T3 difference.There was no significant difference in MAP between T0,T1,T2 and T3.(P<0.05).3.The group of patients were compared in different time breathing breathing mechanics.The PETCO2 at T2,there was a significant difference between the two groups(P<0.05)But the difference was not statistically significant between group B and C;with the prolongation of pneumoperitoneum,there was a rising trend.There was no significant difference for Ppeak between group C and group A and group B(P>0.05)(P=0.013).There was no significant difference between group A and group C(P>0.05).At T3,there was no significant difference between group A and group C(P<0.05)There was no significant difference between group C and group A and group B(P> 0.05).There was no significant difference between group C and group A and group B(P> 0.05).The three groups of Pmean at T1,T2,T3 were all rising up,and there was statistically significant;The group B and group C at T3 comparing with the T1,there was going up and was statistically significant.Group B,group C is higher than group A,group C statistically higher,and there was statistically significant(P> 0.05).The frequency of respiratory rate(RR)was statistically different(P=0.01)at T1 timepoints,and there was significant difference between group A and group B and group C.(P<0.05).The RR of group B was increased at both time points of T2 and T3 and all of them were statistically significant(P<0.05).The results of group C were similar to those of group B group.4.There was no significant difference in PH between the three groups at PH and group.There was a slight decrease trend in group A and group B with prolonged pneumoperitoneum,while group C had a slight decrease after establishment of pneumoperitoneum The trend is basically the same.Pa CO2 was not statistically significant at T0(P>0.05),and there was a significant trend in the rest of T1,T2,T3 time points and Pa CO2 increased when pneumocyte was established.Pa O2 was not statistically different between the three groups at T0,T1 and T3.There was significant difference between the three groups at the time of T4(P = 0.011),and between group A and group B and group C Statistically significant(P = 0.012 and 0.007,respectively),but there was no significant difference between group B and group C.Sp O2 was not statistically different between T0,T1,T3 and T4 at the four time points.5.Comparison of the number of patients who had anesthesia recovery time and PACU after extubation.There was no significant difference in the residence time of postoperative anesthesia recovery room(PACU)between the three groups(P> 0.05).There was no significant difference in the number of oxygen patients after extubation(P>0.05).6.Comparison of postoperative complications The three groups of patients without postoperative pulmonary complications,but also no other serious complications,patients were discharged after 4 days.During the follow-up procedure,the postoperative complications were observed within 4 days(4 days after discharge).(P=0.068).There was no significant difference between group A and group C(P =0.015).There was no significant difference between group B andgroup C(P=0.068),but there was no significant difference between group B and group C Learning meaning.Conclusion: 1.Application of I:E=1:1 combined PEEP=5cm H2 O is superior to conventional mechanical ventilation mode or equal ratio ventilationmode,in the gynecological laparoscopic pneumoperitoneum and Trendelenburg position decreased airway peak pressure while increasing average Airway pressure,while improving oxygenation without adverse respiratory dynamics and hemodynamic effects.2.Gynecological laparoscopic surgery pneumoperitoneum I:E=1:1 combined with PEEP=5cm H2 O ventilation model to reduce the incidence of postoperative complications,more suitable for gynecological laparoscopic surgery ventilation mode. |
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