【罂粟摘要】术中食管测压指导下呼气末正压设置对腹腔镜妇科手术氧合和呼吸力学的影响：一项随机对照试验
术中食管测压指导下呼气末正压设置对腹腔镜妇科手术氧合和呼吸力学的影响：一项随机对照试验
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
腹腔镜手术中产生气腹可能会对呼吸系统造成不良影响。呼气末正压(PEEP)在腹腔镜手术机械通气中起着重要作用。
评价腹腔镜妇科手术中食道压力(POESO)指导下的PEEP设置对氧合和呼吸力学的影响。
一项随机对照研究。
44例接受腹腔镜妇科手术，且预计手术时间超过2小时的成年患者。
干预组的PEEP按食道压力(POESO)设定，对照组PEEP恒定设定在5cmH2O。
分别于诱导插管后(T0)、气腹开始后15min和60min(T1和T2)进行气体交换和呼吸力学检测。
干预组气腹期间呼气末正压明显高于对照组(T1, 12.5±1.9 vs. 5.0±0.0 cmH2O ；T2,12.4±1.9 vs. 5.0±0.0 cmH2O, P<0.001)。对照组气腹期间氧分压较基线显着降低，而干预组无明显变化。尽管如此，氧分压的变化在不同组之间并没有不同。两组气腹期间呼吸系统顺应性明显降低，驱动压显著升高。而干预组CRS和驱动压的变化明显小于干预组。干预组呼气时跨肺压保持不变，而对照组则明显降低。
食道压力(POESO)指导下的PEEP设置对腹腔镜妇科手术患者的氧合无明显影响，但对呼吸力学有较好的影响。
Effects of intra-operative positive end-expiratory pressure setting guided by oesophageal pressure measurement on oxygenation and respiratory mechanics during laparoscopic gynaecological surgery：A randomised controlled trial
Abstract
BACKGROUND The creation of pneumoperitoneum during laparoscopic surgery can lead to adverse effects on the respiratory system. Positive end-expiratory pressure (PEEP) plays an important role in mechanical ventilation during laparoscopic surgery.
OBJECTIVE To evaluate whether PEEP setting guided by oesophageal pressure (Poeso) measurement would affect oxygenation and respiratory mechanics during laparoscopic gynaecological surgery.
DESIGN A randomised controlled study.
SETTING A single-centre trial from March 2018 to June 2018.
PATIENTS Forty-four adult patients undergoing laparoscopic gynaecological surgery with anticipated duration of surgery more than 2 h.
INTERVENTION PEEP set according to Poesomeasurement (intervention group) versus PEEP constantly set at 5 cmH2O (control group).
MAIN OUTCOME MEASURES Gas exchange and respiratory mechanics after induction and intubation (T0) and at 15 and 60 min after initiation of pneumoperitoneum (T1 and T2,
respectively).
RESULTS PEEP during pneumoperitoneum was significantly higher in the intervention group than in the control group (T1, 12.5±1.9 vs. 5.0±0.0 cmH2O ；T2,12.4±1.9 vs. 5.0±0.0 cmH2O, P<0.001). Partial pressures of oxygen decreased significantly from baseline during pneumoperitoneum in the control group but not in the intervention group. Nevertheless, the changes in partial pressures of oxygen did not differ between groups. Compliance of the respiratory system (CRS) significantly decreased and driving pressure significantly increased during pneumoperitoneum in both groups. However, the changes in CRS and driving pressure were significantlylessintheintervention group. Transpulmonary pressure during expiration was maintained in the intervention group while it decreased significantly in the control group.
CONCLUSION PEEP setting guided by Poesomeasurement showed no beneficial effects in terms of oxygenation but respiratory mechanics were better during laparoscopic gynaecological surgery.
原始文献来源：
Hu AM, Qiu Y, Zhang P, et al.Higher versus lower mean arterial pressure target management in older patients having non-cardiothoracic surgery: A prospective randomized controlled trial.J Clin Anesth 2021 Jan 06;69.
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翻译：牛振瑛
编辑：佟睿
审校：曹莹