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2013, vol. 70, br. 1, str. 9-15
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Efekti mehaničke ventilacije kontrolisane pritiskom kod osoba sa oštećenjem respiratorne funkcije tokom laparoskopske holecistektomije
Effect of mechanical pressure-controlled ventilation in patients with disturbed respiratory function during laparoscopic cholecystectomy
aVojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
bMinistarstvo odbrane Republike Srbije, Beograd
cVojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd
dVojnomedicinska akademija, Odsek za prevenciju i kontrolu bolničkih infekcija, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
eVojnomedicinska akademija, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
Sažetak
Uvod/Cilj. Danas se laparoskopska holecistektomija (LH) smatra 'zlatnim standardom' za laparoskopsku hirurgiju. Kod bolesnika sa pratećim oštećenjem respiratorne funkcije, međutim, pneumoperitoneum i položaj bolesnika neophodni za izvođenje procedure LH, dovode do dodatne intraoperativne respiratorne disfunkcije koja predstavlja izazov za anesteziologa. Cilj našeg istraživanja bio je da se utvrdi koji od dva primenjena modusa mehaničke ventilacije obezbeđuje bolje ventilatorne parametre i parametre oksigenacije tokom izvođenja anestezije za LH kod bolesnika koji pripadaju grupi III prema American Society of Anaesthesiologists (ASA) klasifikaciji zbog pratećih respiratornih oboljenja. Metode. Ispitivanjem su obuhvaćene dve grupe po 30 bolesnika podvrgnute LH. Prva grupa bila je ventilisana primenom tipa intermitentnog pozitivnog pritiska u vazdušnim putevima (grupa IPPV), a druga primenom tipa ventilacije kontrolisane pritiskom (grupa PCV). U četiri vremenska intervala praćeni su respiratorni parametri: respiratorni volumen (VT), vršni inspiratorni pritisak (PIP), komplijansa (C), parcijalni pritisak CO2 na kraju ekspirijuma (PETCO2), saturacija arterijske krvi kiseonikom (SpO2), parcijalni pritisci kiseonika i ugljen-dioksida u arterijskoj krvi (PaO2 i PaCO2) i pH arterijske krvi. Rezultati. Nalazi VT, SpO2, PaO2, Pa-CO2 i pH nisu se statistički značajno razlikovali ni unutar, ni između grupa. U vremenskom intervalu t1 nije bilo statistički značajne razlike u vrednostima PIP, C, PETCO2 između IPPV i PCV grupe. U sledeća tri vremenska intervala bilo je statistički značajne do visokoznačajne razlike u vrednostima ova tri respiratorna parametra između dve ispitivane grupe: PIP je bio manji, a C i PETCO2 bili su veći u PCV grupi. Zaključak. Mehanička ventilacija tipa PCV obezbeđuje bolje intraoperativne parametre ventilacije tokom izvođenja LH kod bolesnika koji pripadaju grupi III prema ASA klasifikaciji zbog pratećih respiratornih oboljenja.
Abstract
Background/Aim: Laparoscopic cholecystectomy is considered to be the gold standard for laparoscopic surgical procedures. In ASA III patients with concomitant respiratory diseases, however, creation of pneumoperitoneum and the position of patients during surgery exert additional negative effect on intraoperative respiratory function, thus making a higher challenge for the anesthesiologist than for the surgeon. The aim of this study was to compare the effect of intermittent positive pressure ventilation (IPPV) and pressure controlled ventilation (PCV) during general anesthesia on respiratory function in ASA III patients submitted to laparoscopic cholecystectomy. Methods. The study included 60 patients randomized into two groups depending on the mode of ventilation: IPPV or PCV. Respiratory volume (VT), peak inspiratory pressure (PIP), compliance (C), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2), partial pressures of O2, CO2 (PaO2 and PaCO2) and pH of arterial blood were recorded within four time intervals. Results. There were no statistically significant differences in VT, SpO2, PaO2, PaCO2 and pH values neither within nor between the two groups. In time interval t1 there were no statistically significant differences in PIP, C, PETCO2 values between the IPPV and the PCV group. But, in the next three time intervals there was a difference in PIP, C, and PETCO2 values between the two groups which ranged from statistically significant to highly significant; PIP was lower, C and PETCO2 were higher in the PCV group. Conclusion. Pressure controlled ventilation better maintains stability regarding intraoperative ventilatory parameters in ASA III patients with concomitant respiratory diseases during laparoscopic cholecystectomy.
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