妇科腹腔镜手术通气策略的研究进展_West China Medical Journal

Authors：

东利宁 ,  罗志锴

延安大学附属医院麻醉科（陕西延安 716000）;

Corresponding author：

罗志锴, Email: lzk1821@126.com

Keywords：

妇科腹腔镜手术; 通气; 肥胖; 喉罩

DOI：

10.7507/1002-0179.201606111

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

腹腔镜在妇科手术中已被广泛应用，于妇科腹腔镜手术的麻醉研究也相应增多，而二氧化碳气腹引起的相关不良反应（高碳酸血症、低氧血症、呼吸机相关性肺损伤、术后认知功能障碍等）并未引起麻醉医生的高度重视。该文通过综述近年来妇科腹腔镜手术中不同通气策略（不同吸入氧浓度、适当增加分钟通气量、针对肥胖患者的几种通气模式以及喉罩通气策略）对患者的影响，旨在为妇科腹腔镜手术乃至其他科室的腹腔镜手术麻醉管理提供参考依据。

Citation： 东利宁, 罗志锴. 妇科腹腔镜手术通气策略的研究进展. West China Medical Journal, 2017, 32(7): 1104-1107. doi: 10.7507/1002-0179.201606111 Copy

1.	王帅. 腹腔镜在妇科急腹症中的临床应用探讨. 安徽医药, 2012, 16(10): 1492-1493.
2.	Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: anaesthetic and surgical considerations. J Minim Access Surg, 2010, 6(4): 91-94.
3.	Andersson LE, Bååth M, Thörne A, et al. Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomography. Anesthesiology, 2005, 102(2): 293-299.
4.	Kim MS, Bai SJ, Lee JR, et al. Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol, 2014, 28(7): 801-806.
5.	Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia. Br J Anaesth, 2003, 91(1): 61-72.
6.	Zoremba M, Dette F, Hunecke T, et al. The influence of perioperative Oxygen concentration on postoperative lung function in moderately obese adults. Eur J Anaesthesiol, 2010, 27(6): 501-507.
7.	耿桂启, 李宁, 李泓, 等. 不同吸入氧浓度对妇科腹腔镜手术患者肺顺应性及氧合的影响. 复旦学报: 医学版, 2012, 39(1): 53-55.
8.	孙振涛, 孙雪青, 韩雪萍, 等. 不同呼吸参数对妇科腹腔镜手术后早期认知功能的影响. 临床麻醉学杂志, 2014, 30(7): 686-688.
9.	Moustafa AA, Abdelazim IA. Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries. J Clin Monit Comput, 2016, 30(3): 333-339.
10.	张望平, 祝胜美. 反比通气对超体重患者妇科腹腔镜手术中呼吸功能的影响. 医学研究杂志, 2014, 43(1): 96-99.
11.	Sinha M, Chiplonkar S, Ghanshani R. Pressure-controlled inverse ratio ventilation using laryngeal mask airway in gynecological laparoscopy. J Anaesthesiol Clin Pharmacol, 2012, 28(3): 330-333.
12.	Kim WH, Hahm TS, Kim JA, et al. Prolonged inspiratory time produces better gas exchange in patients undergoing laparoscopic surgery: a randomised trial. Acta Anaesthesiol Scand, 2013, 57(5): 613-622.
13.	Kim MS, Kim NY, Lee KY, et al. The impact of two different inspiratory to expiratory ratios (1∶1 and 1∶2) on respiratory mechanics and oxygenation during volume-controlled ventilation in robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Can J Anaesth, 2015, 62(9): 979-987.
14.	Futier E, Constantin JM, Pelosi P, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy. Anesthesiology, 2010, 113(6): 1310-1319.
15.	Maisch S, Reissmann H, Fuellekrug B, et al. Compliance and dead space fraction indicate an optimal level of positive end-expiratory pressure after recruitment in anesthetized patients. Anesth Analg, 2008, 106(1): 175-181, table of contents.
16.	Severgnini P, Selmo G, Lanza C, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology, 2013, 118(6): 1307-1321.
17.	Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med, 2013, 369(5): 428-437.
18.	Grieco DL, Russo A, Vallecoccia MS, et al. Lung protective vs. standard ventilation during laparoscopic surgery in obese patients. Preliminary results of a randomized, controlled trial. Int Care Medicine Experimental, 2015, 3(S1): A683.
19.	Park SJ, Kim BG, Oh AH, et al. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc, 2016, 158(5): 1-9.
20.	王翔锋, 陈彦青, 戴双波. 压力和容量通气模式对肥胖患者腹腔镜手术中呼吸功能的影响. 国际麻醉学与复苏杂志, 2010, 31(5): 404-407.
21.	Sen O, Umutoglu T, Aydın N, et al. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy. Springerplus, 2016, 5: 298.
22.	Choi EM, Na S, Choi SH, et al. Comparison of volume-controlled and pressure-controlled ventilation in steep Trendelenburg position for robot-assisted laparoscopic radical prostatectomy. J Clin Anesth, 2011, 23(3): 183-188.
23.	Komasawa N, Kusunoki T, Soen M, et al. Airway rescue in a patient with severe obstructive sleep apnea syndrome and impossible ventilation after induction of general anesthesia. Masui, 2014, 63(6): 644-646.
24.	Saran S, Mishra SK, Badhe AS, et al. Comparison of i-gel supraglottic airway and LMA-ProSeal^TM in pediatric patients under controlled ventilation. J Anaesthesiol Clin Pharmacol, 2014, 30(20): 195-198.
25.	Maltby JR, Beriault MT, Watson NC, et al. Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-Classic vs. tracheal intubation. Can J Anaesth, 2000, 47(7): 622-626.
26.	沈玲. 喉罩通气在妇科腹腔镜手术中的应用. 中外医学研究, 2014, 12(19): 36-37.
27.	Carron M, Freo U, Ori C. Usefulness of spirometry in air leak evaluation during laparoscopic surgery in an obese patient with laryngeal mask airway Supreme^TM. Br J Anaesth, 2010, 105(3): 387-389.
28.	Jeon WJ, Cho SY, Bang MR, et al. Comparison of volume-controlled and pressure-controlled ventilation using a laryngeal mask airway during gynecological laparoscopy. Korean J Anesthesiol, 2011, 60(3): 167-172.
29.	王家武, 李娟, 唐朝亮, 等. 压力控制反比通气在 I-gel 喉罩全麻妇科腹腔镜手术中的应用. 安徽医药, 2014, 18(9): 1717-1719.
30.	陈䶮, 沈江, 洪涛. I-gel 喉罩在妇科腹腔镜手术中的应用. 世界最新医学信息文摘, 2015, 15(104): 102-104.
31.	Bhavani-Shankar K, Steinbrook RA, Brooks DC, et al. Arterial to end-tidal carbon dioxide pressure difference during laparoscopic surgery in pregnancy. Anesthesiology, 2000, 93(2): 370-373.
32.	Klopfenstein CE, Schiffer E, Pastor CM, et al. Laparoscopic colon surgery: unreliability of end-tidal CO₂ monitoring. Acta Anaesthesiol Scand, 2008, 52(5): 700-707.
33.	廖婧华, 林财珠, 高友光. 气腹对动脉血-呼气末二氧化碳分压差的影响. 临床麻醉学杂志, 2012, 28(8): 767-769.
34.	曹开梅, 王晓芳, 王清兵, 等. 喉罩应用于妇科腹腔镜手术. 世界最新医学信息文摘: 连续型电子期刊, 2016, 16(48): 13-14.

1. 王帅. 腹腔镜在妇科急腹症中的临床应用探讨. 安徽医药, 2012, 16(10): 1492-1493.
2. Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: anaesthetic and surgical considerations. J Minim Access Surg, 2010, 6(4): 91-94.
3. Andersson LE, Bååth M, Thörne A, et al. Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomography. Anesthesiology, 2005, 102(2): 293-299.
4. Kim MS, Bai SJ, Lee JR, et al. Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol, 2014, 28(7): 801-806.
5. Magnusson L, Spahn DR. New concepts of atelectasis during general anaesthesia. Br J Anaesth, 2003, 91(1): 61-72.
6. Zoremba M, Dette F, Hunecke T, et al. The influence of perioperative Oxygen concentration on postoperative lung function in moderately obese adults. Eur J Anaesthesiol, 2010, 27(6): 501-507.
7. 耿桂启, 李宁, 李泓, 等. 不同吸入氧浓度对妇科腹腔镜手术患者肺顺应性及氧合的影响. 复旦学报: 医学版, 2012, 39(1): 53-55.
8. 孙振涛, 孙雪青, 韩雪萍, 等. 不同呼吸参数对妇科腹腔镜手术后早期认知功能的影响. 临床麻醉学杂志, 2014, 30(7): 686-688.
9. Moustafa AA, Abdelazim IA. Impact of obesity on recovery and pulmonary functions of obese women undergoing major abdominal gynecological surgeries. J Clin Monit Comput, 2016, 30(3): 333-339.
10. 张望平, 祝胜美. 反比通气对超体重患者妇科腹腔镜手术中呼吸功能的影响. 医学研究杂志, 2014, 43(1): 96-99.
11. Sinha M, Chiplonkar S, Ghanshani R. Pressure-controlled inverse ratio ventilation using laryngeal mask airway in gynecological laparoscopy. J Anaesthesiol Clin Pharmacol, 2012, 28(3): 330-333.
12. Kim WH, Hahm TS, Kim JA, et al. Prolonged inspiratory time produces better gas exchange in patients undergoing laparoscopic surgery: a randomised trial. Acta Anaesthesiol Scand, 2013, 57(5): 613-622.
13. Kim MS, Kim NY, Lee KY, et al. The impact of two different inspiratory to expiratory ratios (1∶1 and 1∶2) on respiratory mechanics and oxygenation during volume-controlled ventilation in robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Can J Anaesth, 2015, 62(9): 979-987.
14. Futier E, Constantin JM, Pelosi P, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy. Anesthesiology, 2010, 113(6): 1310-1319.
15. Maisch S, Reissmann H, Fuellekrug B, et al. Compliance and dead space fraction indicate an optimal level of positive end-expiratory pressure after recruitment in anesthetized patients. Anesth Analg, 2008, 106(1): 175-181, table of contents.
16. Severgnini P, Selmo G, Lanza C, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology, 2013, 118(6): 1307-1321.
17. Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med, 2013, 369(5): 428-437.
18. Grieco DL, Russo A, Vallecoccia MS, et al. Lung protective vs. standard ventilation during laparoscopic surgery in obese patients. Preliminary results of a randomized, controlled trial. Int Care Medicine Experimental, 2015, 3(S1): A683.
19. Park SJ, Kim BG, Oh AH, et al. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc, 2016, 158(5): 1-9.
20. 王翔锋, 陈彦青, 戴双波. 压力和容量通气模式对肥胖患者腹腔镜手术中呼吸功能的影响. 国际麻醉学与复苏杂志, 2010, 31(5): 404-407.
21. Sen O, Umutoglu T, Aydın N, et al. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during laparoscopic cholecystectomy. Springerplus, 2016, 5: 298.
22. Choi EM, Na S, Choi SH, et al. Comparison of volume-controlled and pressure-controlled ventilation in steep Trendelenburg position for robot-assisted laparoscopic radical prostatectomy. J Clin Anesth, 2011, 23(3): 183-188.
23. Komasawa N, Kusunoki T, Soen M, et al. Airway rescue in a patient with severe obstructive sleep apnea syndrome and impossible ventilation after induction of general anesthesia. Masui, 2014, 63(6): 644-646.
24. Saran S, Mishra SK, Badhe AS, et al. Comparison of i-gel supraglottic airway and LMA-ProSeal^TM in pediatric patients under controlled ventilation. J Anaesthesiol Clin Pharmacol, 2014, 30(20): 195-198.
25. Maltby JR, Beriault MT, Watson NC, et al. Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-Classic vs. tracheal intubation. Can J Anaesth, 2000, 47(7): 622-626.
26. 沈玲. 喉罩通气在妇科腹腔镜手术中的应用. 中外医学研究, 2014, 12(19): 36-37.
27. Carron M, Freo U, Ori C. Usefulness of spirometry in air leak evaluation during laparoscopic surgery in an obese patient with laryngeal mask airway Supreme^TM. Br J Anaesth, 2010, 105(3): 387-389.
28. Jeon WJ, Cho SY, Bang MR, et al. Comparison of volume-controlled and pressure-controlled ventilation using a laryngeal mask airway during gynecological laparoscopy. Korean J Anesthesiol, 2011, 60(3): 167-172.
29. 王家武, 李娟, 唐朝亮, 等. 压力控制反比通气在 I-gel 喉罩全麻妇科腹腔镜手术中的应用. 安徽医药, 2014, 18(9): 1717-1719.
30. 陈䶮, 沈江, 洪涛. I-gel 喉罩在妇科腹腔镜手术中的应用. 世界最新医学信息文摘, 2015, 15(104): 102-104.
31. Bhavani-Shankar K, Steinbrook RA, Brooks DC, et al. Arterial to end-tidal carbon dioxide pressure difference during laparoscopic surgery in pregnancy. Anesthesiology, 2000, 93(2): 370-373.
32. Klopfenstein CE, Schiffer E, Pastor CM, et al. Laparoscopic colon surgery: unreliability of end-tidal CO₂ monitoring. Acta Anaesthesiol Scand, 2008, 52(5): 700-707.
33. 廖婧华, 林财珠, 高友光. 气腹对动脉血-呼气末二氧化碳分压差的影响. 临床麻醉学杂志, 2012, 28(8): 767-769.
34. 曹开梅, 王晓芳, 王清兵, 等. 喉罩应用于妇科腹腔镜手术. 世界最新医学信息文摘: 连续型电子期刊, 2016, 16(48): 13-14.

Previous Article
循环肿瘤细胞检测及 SE-iFISH 技术检测循环肿瘤细胞的临床应用
Next Article
宫颈卵巢原发性双癌和宫颈癌卵巢转移的临床分析

West China Medical Journal

妇科腹腔镜手术通气策略的研究进展

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content