Progress of controlled hyperventilation in laparoscopic surgery_West China Medical Journal

Authors：

 DAI Lingjie ¹ , YUAN Qingxia ²

1. Department of Anesthesia, Yan’an University Affiliated Hospital, Yan’an, Shaanxi 716000, P. R. China;
2. Department of Critical Care Medicine, Yan’an University Affiliated Hospital, Yan’an, Shaanxi 716000, P. R. China;

Corresponding author：

DAI Lingjie, Email: 1320352157@qq.com

Keywords：

Hyperventilation; Laparoscopy; Carbon dioxide pneumoperitoneum; Hypercapnia

DOI：

10.7507/1002-0179.201909173

Video：

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With the extensive application of laparoscopy in clinical surgery, the advantages of laparoscopic surgery such as less intraoperative bleeding, small and beautiful incision, and rapid postoperative recovery become increasingly prominent. However, prolonged use of carbon dioxide (CO₂) pneumoperitoneum or high CO₂ pneumoperitoneum pressure during laparoscopic surgery may cause subcutaneous emphysema and hypercapnia, in severe cases which may affect the quality of recovery and prognosis of patients. The use of a protective ventilation strategy during laparoscopic surgery under general anesthesia, a mechanical ventilation model of controlled hyperventilation, can reduce or avoid the effects of hypercapnia caused by prolonged CO₂ pneumoperitoneum or high CO₂ pneumoperitoneum pressure. This article reviews the effects of laparoscopic CO₂ pneumoperitoneum on patients, the application of controlled hyperventilation in laparoscopic surgery under general anesthesia and the effects of controlled hyperventilation on patients. The aim is to provide a theoretical basis for the safe and effective application of controlled hyperventilation in laparoscopic surgery.

Citation： DAI Lingjie, YUAN Qingxia. Progress of controlled hyperventilation in laparoscopic surgery. West China Medical Journal, 2020, 35(2): 220-224. doi: 10.7507/1002-0179.201909173 Copy

1.	樊利华, 游存厚, 姜雯. 腹腔镜手术中 CO₂ 气腹对机体生理功能的影响. 疾病监测与控制, 2017, 11(9): 708-710.
2.	万玉骁, 朱俊超. 肺保护性通气策略在新生儿胸腔镜手术中对脑氧饱和度的影响. 中国医科大学学报, 2018, 47(5): 385-389.
3.	高志刚, 刘群. 保护性肺通气的研究与应用. 医学综述, 2004, 10(10): 618-620.
4.	Heffner JE, Sahn SA. Controlled hyperventilation in patients with intracranial hypertension. Application and management. Arch Intern Med, 1983, 143(4): 765-769.
5.	梁仕伟, 林春水, 古妙宁. 轻度过度通气下施行 CO₂ 气腹对呼吸和动脉血气的影响. 第一军医大学学报, 2001, 21(2): 121-122, 125.
6.	Buijze GA, Hopman MT. Controlled hyperventilation after training may accelerate altitude acclimatization. Wilderness Environ Med, 2014, 25(4): 484-486.
7.	Talakoub R, Khodayari A, Saghaei M. Effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation. Middle East J Anaesthesiol, 2003, 17(3): 403-413.
8.	辛栋轶, 蒋金伟, 解晶, 等. 不同气腹压力对腹腔镜胆囊切除术后肝功能、炎症因子及免疫功能的影响. 现代实用医学, 2016, 28(2): 227-229.
9.	Schietroma M, Pessia B, Stifini D, et al. Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: a prospective randomised study. J Minim Access Surg, 2016, 12(2): 109-117.
10.	Roh GU, Kim WO, Rha KH, et al. Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy. Arch Gerontol Geriatr, 2016, 64: 167-171.
11.	Rauh R, Hemmerling TM, Rist M, et al. Influence of pneumoperitoneum and patient positioning on respiratory system compliance. J Clin Anesth, 2001, 13(5): 361-365.
12.	王磊, 吴婧, 杨丽娜, 等. 允许性高碳酸血症在腹腔镜直肠癌手术中的应用及对循环的影响. 现代生物医学进展, 2019, 19(11): 2167-2171.
13.	尹增盛, 李淑琴, 崔辉. 不同压力二氧化碳气腹对老年腹腔镜胆囊切除术患者术后认知功能的影响. 医学信息, 2018, 31(20): 86-87, 90.
14.	徐辉, 郭永章, 陈训如. CO₂ 气腹对正常大鼠脑组织 S-100、NSE mRNA 和蛋白水平的影响. 消化外科, 2006, 5(4): 274-277.
15.	Li XM, Shao MT, Wang JJ, et al. Relationship between post-operative cognitive dysfunction and regional cerebral oxygen saturation and β-amyloid protein. J Zhejiang Univ Sci B, 2014, 15(10): 870-878.
16.	Cleutjens FA, Janssen DJ, Ponds RW, et al. Cognitive-pulmonary disease. Biomed Res Int, 2014, 2014: 697825.
17.	左艳霞, 秦寿泽, 张凤敏, 等. 妇科腹腔镜手术中气腹与非气腹对呼吸、循环功能及眼内压影响的比较. 疑难病杂志, 2016, 15(7): 720-724.
18.	Dec M, Andruszkiewicz P. Anaesthesia for minimally invasive surgery. Wideochir Inne Tech Maloinwazyjne, 2016, 10(4): 509-514.
19.	蒙炯, 万智恒, 祁凤灵. 腹腔镜手术中二氧化碳气腹副作用的研究现状. 中国伤残医学, 2015, 23(6): 212-213.
20.	王玉顺. 不同通气策略配合低压力二氧化碳气腹在后腹腔镜手术中的运用. 临床医药文献电子杂志, 2018, 5(50): 67, 69.
21.	Nasajiyan N, Javaherfourosh F, Ghomeishi A, et al. Comparison of low and standard pressure gas injection at abdominal cavity on postoperative nausea and vomiting in laparoscopic cholecystectomy. Pak J Med Sci, 2014, 30(5): 1083-1087.
22.	杨德君, 傅红兵, 程亚军, 等. 腹腔镜胃癌根治术不同气腹压力对肠道的影响. 中华胃肠外科杂志, 2014, 17(2): 163-167.
23.	黄润强, 郭振鹏, 袁修琼, 等. 低分子肝素钙在妇科肿瘤腹腔镜术后预防深静脉血栓中的临床效果. 现代肿瘤医学, 2017, 25(3): 444-447.
24.	万亮, 李忠廉, 张西波. 腹腔镜与开腹胆囊切除术后凝血及纤溶系统的变化. 山东医药, 2014, 54(32): 82-84.
25.	王欣. CO₂ 气腹腹腔镜手术对凝血/纤溶系统的影响. 石家庄: 河北医科大学, 2008.
26.	周志涛, 何伟良, 范隼, 等. 腹腔镜胆囊切除术气腹时间对患者凝血、纤溶系统活性及血管内皮细胞活性的影响. 四川医学, 2018, 39(11): 1238-1241.
27.	Larsen JF, Ejstrud P, Svendsen F, et al. Systemic response in patients undergoing laparoscopic cholecystectomy using gasless or carbon dioxide pneumoperitoneum: a randomized study. J Gastrointest Surg, 2002, 6(4): 582-586.
28.	王亚男, 黄向华, 王振海. 腹腔镜手术对机体内分泌及代谢影响的研究进展. 国外医学 (妇产科学分册), 2005, 32(4): 250-253.
29.	王蕾蕾, 黄贞玲, 周仁龙, 等. 腹腔与腹膜后二氧化碳气腹对抗利尿激素、醛固酮和尿量的影响. 上海医学, 2015, 38(12): 891-895.
30.	姚明, 常向阳, 方芬. 全身麻醉苏醒延迟 8 例的教训与处理. 临床麻醉学杂志, 1998, 14(3): 202.
31.	王鹏. 后腹腔镜肾切除术致广泛皮下气肿并苏醒延迟 1 例报告. 腹腔镜外科杂志, 2016, 21(3): 180, 188.
32.	冉雪莲, 陈峻. 腹腔镜结直肠手术后二氧化碳残留对患者苏醒质量的影响. 中国临床新医学, 2016, 9(9): 794-798.
33.	段波, 黄胜, 陈荭, 等. 高压氧治疗腹腔镜手术麻醉苏醒延迟 1 例. 重庆医学, 2006, 35(19): 1750.
34.	王效德, 郭素香, 董希玮, 等. 轻度过度通气对妇科腹腔镜手术患者麻醉恢复期及 S-100β、NSE 的影响. 山东医药, 2012, 52(40): 82-85.
35.	王纯辉, 李元海, 徐志荣, 等. 过度通气对腹腔镜手术 CO₂ 气腹前后 P_ETCO₂ 及动脉血气的影响. 安徽医科大学学报, 2002, 37(4): 309-311.
36.	安尔丹, 祝胜美. 后腹腔镜手术中不同通气策略对动脉血气参数的影响. 浙江医学, 2008, 30(12): 1319-1320.
37.	袁燕波, 颜明. 气管插管后行过度通气对后腹腔镜手术患者术中肺功能的影响. 医学研究杂志, 2018, 47(9): 147-150.
38.	Jo YY, Kwak HJ. What is the proper ventilation strategy during laparoscopic surgery?. Korean J Anesthesiol, 2017, 70(6): 596-600.
39.	刘礼军, 王强, 鲍方, 等. 单肺通气时吸入不同浓度氧对围术期氧合的影响. 临床麻醉学杂志, 2015, 31(4): 350-353.

1. 樊利华, 游存厚, 姜雯. 腹腔镜手术中 CO₂ 气腹对机体生理功能的影响. 疾病监测与控制, 2017, 11(9): 708-710.
2. 万玉骁, 朱俊超. 肺保护性通气策略在新生儿胸腔镜手术中对脑氧饱和度的影响. 中国医科大学学报, 2018, 47(5): 385-389.
3. 高志刚, 刘群. 保护性肺通气的研究与应用. 医学综述, 2004, 10(10): 618-620.
4. Heffner JE, Sahn SA. Controlled hyperventilation in patients with intracranial hypertension. Application and management. Arch Intern Med, 1983, 143(4): 765-769.
5. 梁仕伟, 林春水, 古妙宁. 轻度过度通气下施行 CO₂ 气腹对呼吸和动脉血气的影响. 第一军医大学学报, 2001, 21(2): 121-122, 125.
6. Buijze GA, Hopman MT. Controlled hyperventilation after training may accelerate altitude acclimatization. Wilderness Environ Med, 2014, 25(4): 484-486.
7. Talakoub R, Khodayari A, Saghaei M. Effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation. Middle East J Anaesthesiol, 2003, 17(3): 403-413.
8. 辛栋轶, 蒋金伟, 解晶, 等. 不同气腹压力对腹腔镜胆囊切除术后肝功能、炎症因子及免疫功能的影响. 现代实用医学, 2016, 28(2): 227-229.
9. Schietroma M, Pessia B, Stifini D, et al. Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: a prospective randomised study. J Minim Access Surg, 2016, 12(2): 109-117.
10. Roh GU, Kim WO, Rha KH, et al. Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy. Arch Gerontol Geriatr, 2016, 64: 167-171.
11. Rauh R, Hemmerling TM, Rist M, et al. Influence of pneumoperitoneum and patient positioning on respiratory system compliance. J Clin Anesth, 2001, 13(5): 361-365.
12. 王磊, 吴婧, 杨丽娜, 等. 允许性高碳酸血症在腹腔镜直肠癌手术中的应用及对循环的影响. 现代生物医学进展, 2019, 19(11): 2167-2171.
13. 尹增盛, 李淑琴, 崔辉. 不同压力二氧化碳气腹对老年腹腔镜胆囊切除术患者术后认知功能的影响. 医学信息, 2018, 31(20): 86-87, 90.
14. 徐辉, 郭永章, 陈训如. CO₂ 气腹对正常大鼠脑组织 S-100、NSE mRNA 和蛋白水平的影响. 消化外科, 2006, 5(4): 274-277.
15. Li XM, Shao MT, Wang JJ, et al. Relationship between post-operative cognitive dysfunction and regional cerebral oxygen saturation and β-amyloid protein. J Zhejiang Univ Sci B, 2014, 15(10): 870-878.
16. Cleutjens FA, Janssen DJ, Ponds RW, et al. Cognitive-pulmonary disease. Biomed Res Int, 2014, 2014: 697825.
17. 左艳霞, 秦寿泽, 张凤敏, 等. 妇科腹腔镜手术中气腹与非气腹对呼吸、循环功能及眼内压影响的比较. 疑难病杂志, 2016, 15(7): 720-724.
18. Dec M, Andruszkiewicz P. Anaesthesia for minimally invasive surgery. Wideochir Inne Tech Maloinwazyjne, 2016, 10(4): 509-514.
19. 蒙炯, 万智恒, 祁凤灵. 腹腔镜手术中二氧化碳气腹副作用的研究现状. 中国伤残医学, 2015, 23(6): 212-213.
20. 王玉顺. 不同通气策略配合低压力二氧化碳气腹在后腹腔镜手术中的运用. 临床医药文献电子杂志, 2018, 5(50): 67, 69.
21. Nasajiyan N, Javaherfourosh F, Ghomeishi A, et al. Comparison of low and standard pressure gas injection at abdominal cavity on postoperative nausea and vomiting in laparoscopic cholecystectomy. Pak J Med Sci, 2014, 30(5): 1083-1087.
22. 杨德君, 傅红兵, 程亚军, 等. 腹腔镜胃癌根治术不同气腹压力对肠道的影响. 中华胃肠外科杂志, 2014, 17(2): 163-167.
23. 黄润强, 郭振鹏, 袁修琼, 等. 低分子肝素钙在妇科肿瘤腹腔镜术后预防深静脉血栓中的临床效果. 现代肿瘤医学, 2017, 25(3): 444-447.
24. 万亮, 李忠廉, 张西波. 腹腔镜与开腹胆囊切除术后凝血及纤溶系统的变化. 山东医药, 2014, 54(32): 82-84.
25. 王欣. CO₂ 气腹腹腔镜手术对凝血/纤溶系统的影响. 石家庄: 河北医科大学, 2008.
26. 周志涛, 何伟良, 范隼, 等. 腹腔镜胆囊切除术气腹时间对患者凝血、纤溶系统活性及血管内皮细胞活性的影响. 四川医学, 2018, 39(11): 1238-1241.
27. Larsen JF, Ejstrud P, Svendsen F, et al. Systemic response in patients undergoing laparoscopic cholecystectomy using gasless or carbon dioxide pneumoperitoneum: a randomized study. J Gastrointest Surg, 2002, 6(4): 582-586.
28. 王亚男, 黄向华, 王振海. 腹腔镜手术对机体内分泌及代谢影响的研究进展. 国外医学 (妇产科学分册), 2005, 32(4): 250-253.
29. 王蕾蕾, 黄贞玲, 周仁龙, 等. 腹腔与腹膜后二氧化碳气腹对抗利尿激素、醛固酮和尿量的影响. 上海医学, 2015, 38(12): 891-895.
30. 姚明, 常向阳, 方芬. 全身麻醉苏醒延迟 8 例的教训与处理. 临床麻醉学杂志, 1998, 14(3): 202.
31. 王鹏. 后腹腔镜肾切除术致广泛皮下气肿并苏醒延迟 1 例报告. 腹腔镜外科杂志, 2016, 21(3): 180, 188.
32. 冉雪莲, 陈峻. 腹腔镜结直肠手术后二氧化碳残留对患者苏醒质量的影响. 中国临床新医学, 2016, 9(9): 794-798.
33. 段波, 黄胜, 陈荭, 等. 高压氧治疗腹腔镜手术麻醉苏醒延迟 1 例. 重庆医学, 2006, 35(19): 1750.
34. 王效德, 郭素香, 董希玮, 等. 轻度过度通气对妇科腹腔镜手术患者麻醉恢复期及 S-100β、NSE 的影响. 山东医药, 2012, 52(40): 82-85.
35. 王纯辉, 李元海, 徐志荣, 等. 过度通气对腹腔镜手术 CO₂ 气腹前后 P_ETCO₂ 及动脉血气的影响. 安徽医科大学学报, 2002, 37(4): 309-311.
36. 安尔丹, 祝胜美. 后腹腔镜手术中不同通气策略对动脉血气参数的影响. 浙江医学, 2008, 30(12): 1319-1320.
37. 袁燕波, 颜明. 气管插管后行过度通气对后腹腔镜手术患者术中肺功能的影响. 医学研究杂志, 2018, 47(9): 147-150.
38. Jo YY, Kwak HJ. What is the proper ventilation strategy during laparoscopic surgery?. Korean J Anesthesiol, 2017, 70(6): 596-600.
39. 刘礼军, 王强, 鲍方, 等. 单肺通气时吸入不同浓度氧对围术期氧合的影响. 临床麻醉学杂志, 2015, 31(4): 350-353.

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