Small Tidal Volume And Techniques Sighs Ventilation In The Application Of Laparoscopic Cholecystectomy

Objective: In laparoscopic cholecystectomy,we need a carbon dioxide gas.The effects of co2 on respiratory function include changing the dynamics of breathing,affecting the function of the pulmonary circulation,and the absorption of carbon dioxide into the blood.Intraoperative breathing management,should notice to protect lung function,maintain adequate gas exchange,making tissue oxygenation,reduce or avoid interference hemodynamic [1-2],reduce ventilator associated lung injury.In traditional mechanical ventilation,the tidal volume is usually 10-15ml/kg.This is higher than the amount of moisture in the patient’s resting state(7-8ml/kg),which tends to cause the hyperexpansion of the alveoli and the increased suction pressure,resulting in pressure-capacity lung damage.However,a small amount of moisture(6-8 ml/kg)can prevent this phenomenon from [3].Clinically often choose small tidal volume or by a combination of small tidal volume PEEP or recruitment maneuve [4] to protect lung function,can prevent pulmonary barotrauma,and can reduce the occurrence of atelectasis,pulmonary atelectatic and decreased lung water content,make out at the end of the volume increase,improve lung compliance,improve oxygenation [5].The sigh method belongs to the lung to duplicate one kind,A study based on low tidal volume ventilation on the sigh of the acute respiratory distress syndrome(ARDS)patients with pulmonary reexpansion treatment [6],found that persistent sigh can make the patient’s oxygenation and lung compliance were improved,and the hemodynamic effects of mild [7-8].At present,there are few studies on the application of small tidal volume plus manual sigh ventilation as a pulmonary protective ventilation strategy in laparoscopic cholecystectomy.No studies have shown that intermittent ventilation during the duration of controlled ventilation may have positive effects on vital signs and blood gas indices.The purpose of this study was to observe the laparoscopic cholecystectomy in the application of low tidal volume ventilation mode sigh plus manual as the safety and effectiveness of lung protective ventilation strategy.Methods: select elective laparoscopic gallbladder surgery in 45 patients randomly into three groups,each group of 15 cases.Home care patients vital signs,the establishment of intravenous fluid after the lower left had in radial artery puncture tube insertion.we.After anesthesia induction,mouth breathing machine in laryngeal mask connection.Grouping situation is as follows: Ⅰgroups: pneumoperitoneum set before and after mechanical ventilation parameters are: VT8ml/kg,F12 times/min,I: E is 1:2,PEEP5cmH2 O.Ⅱgroups: set up the parameter mechanical ventilation VT8ml/kg before pneumoperitoneum,F12 times/min,I: E is 1:2,PEEP5cmH2 O.Set mechanical ventilation parameters: after pneumoperitoneum VT6ml/kg,F16 times/min,I: E is 1:2,PEEP5cmH2 O.Ⅲgroups: set up the parameter mechanical ventilation VT8ml/kg before pneumoperitoneum,F12 times/min,I: E is 1:2,PEEP5-cmH2 O.Set mechanical ventilation parameters: after pneumoperitoneum VT6ml/kg,f16 times/min,I: E is 1:2,PEEP5cmH2 O.Sighing sighs a set,every 10 minutes total time for 120 seconds,four seconds at a time,a total of 30 times [4].Each skill sigh tidal volume is 1.5 times the tidal volume(VT),and maintain the platform period time accounted for 50% of inspiratory time percentage.Record the mechanical ventilation after 5 minutes before pneumoperitoneum build time T1.Pneumoperitoneum established 10 minutes,20 minutes,30 minutes after recording time for T2,T3,T4,respectively.Pull out the end of the surgery patients awake after laryngeal mask,air record time for T5 10 minutes.Record the time point of the MAP,HR,respectively.On T1-T4 record Ppeak during mechanical ventilation,Pmean,Cdyn,Pet respiratory mechanics indexes such as CO2.In T1,T4 and T5 point 1 ml arterial blood record blood gas index: pH,PaO2 and Pa CO2 and pulmonary oxygenation function index: A-aDO2,OI,RI.Results: the three groups of patients with the general situation is,and each time the MAP,HR,PaO2 there was no significant difference compared between groups.Ppeak and Pmean: three groups during mechanical ventilation,the time contrast T1 were increased(P<0.05);Comparison between groups,each point T2T3T4 group were higher than in group(Ⅲ Ⅰ P< 0.05).The dynamic lung compliance(Cdyn): three groups of mechanical ventilation during each point compared to T1 were lower(P< 0.05);Comparison between groups,30 minutes(T4)pneumoperitoneum above group(Ⅲ Ⅰ P< 0.05).Pet CO2 Ⅰ,T4 contrast T1 Ⅱgroup were increased(P< 0.05),Ⅲgroup each point contrast T1 no significant change(P> 0.05);Comparison between groups,T4,above group Ⅱ Ⅰ P< 0.05),below group(Ⅲ Ⅰ P< 0.05).Record three groups of patients with T1,T4 and T5 point in time when blood gas index: pH: Ⅰ,group,compared with T1,T4 and T5 were lowerⅡ(P< 0.05),group Ⅲ compared with T1,T4,T5,no significant change(P > 0.05);Comparison between groups,T4,T5,Ⅱgroup were lower than Ⅰgroup(P < 0.05),Ⅲgroup were higher than in Ⅰgroup(P < 0.05).PaCO2: Ⅰ,Ⅱgroup,are higher when compared with T1,T4 and T5(P<0.05),group,compared with ⅢT1,T4,T5,no significant change(P> 0.05);Comparison between groups,T4 and T5 group were higher than in group(Ⅱ Ⅰ P< 0.05),group were lower Ⅲthan Ⅰgroup(P<0.05).A-aDO2: in three groups,compared with T1,30 minu-tes after pneumoperitoneum(T4)were significantly increased(P < 0.01),10 minutes after extubation(T5)were significantly lower(P<0.01);Comparison between groups,T4 Ⅱabove Ⅰgroup,T5 Ⅱbelow Ⅰgroup.OI: Ⅰ,Ⅱgroup,compared with T1,10 minutes after extubation(T5)were significantly lower(P< 0.01),group Ⅲcompared with T1,10 minutes after extubation(T5)no significant change(P> 0.05);Comparison between groups,T5 above group(Ⅲ Ⅰ P< 0.05).RI: in three groups,when compared with T1,T5 were significantly lower(P< 0.01),the comparison between groups,there was no significant difference(P> 0.05).Conclusions: in laparoscopic cholecystectomy,the small tidal volume mechanical ventilation plus sigh,can effectively reduce the intraoperative airway pressure,and can increase expiratory volume,at the end of the closed volume,prevention and treatment of collapsed lung,and improve the lung compliance,improve lung tissue oxygenation,therefore,can be used as lung protective ventilation strategy is applied to the respiratory management of laparoscopic cholecystectomy.