Сomparative analysis of respiratory support for endoscopic sleeve gastroplasty in patients with morbid obesity
摘要
For the analysis of the effect of respiratory support on the parameters of external respiration, gas exchange, peripheral and central hemodynamics in endoscopic sleeve gastroplasty in patients with morbid obesity a randomized study of 58 patients with morbid obesity was conducted, in which endoscopic sleeve gastroplasty was performed under combined anesthesia. Depending on the choice of the mode of pulmonary ventilation (PV), the patients were divided into two groups. In the 1st group (n = 28) patients had respiratory support in the volume-controlled ventilation mode (VCV); in the 2nd group (n = 30) they had respiratory support in the pressure-controlled ventilation (PCV) mode. The parameters of central hemodynamics, external respiration, peripheral hemodynamics, ABB were monitored intraoperatively. It was found that a significantly higher level of oxygenation was detected with PCV mode: PaO2 - 96.8 (92.7; 99.8) mm Hg, (PaO2/FiO2) 322.6 (341.2; 304.7) mm Hg in comparison with VCV mode: PaO2 - 92.2 (87.5; 96.3) mm Hg, PaO2/FiO2 - 307.3 (286.2; 331.7) mm Hg, and in second stage of the study (p < 0,05).
关于作者
M. Neimark
Altay State Medical University
俄罗斯联邦
俄罗斯联邦
R. Kiselev
Altay State Medical University
俄罗斯联邦
俄罗斯联邦
参考
1. Finucane MM, Stevens GA, Cowan M, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011; 377(9765): 557-567 .
2. Витебская А.В., Пятницкая К.В. Ожирение и его осложнения в педиатрической практике. Сеченовский весник.2016; 2(24):4-8
3. Bellamy M., Struys M. Anaesthesia for the Overweight and Obese Patient. Oxford UK.: Oxford University Press; 2007. 108p.
4. Bellamy M, Margarson M. Designing intelligent anesthesia for a changing patient demographic: a consensus statement to provide guidance for specialist and non-specialist anesthetists written by members of and endorsed by the Society for Obesity and Bariatric Anaesthesia (SOBA). Perioperative Medicine .2013; 2(1): 12.
5. Gattinoni L, Carlesso E, Cadringher P, Valenza F, Vagginelli F, Chiumello D. Physical and biological triggers of ventilator-induced lung injury and its prevention. Eur Respir J Suppl. 2003; 47(22):15s-25s.
6. Ярошецкий А И, Проценко Д Н, Резепов Н А, Гельфанд Б Р. Настройка положительного давления конца выдоха при паренхиматозной ОДН: статическая петля "давление-объем" или транспульмональное давление? Анестезиология и реаниматология. 2014; 59(4): 53-59.
7. East TD, inʼtVeen J C, Jonker T, Pace N, McJames S. Computer-controlled positive end-expiratory pressure titration for effective oxygenation without frequent blood gases. Critical Care Medicine. 1988; 16(3): 252-257.
8. Gattinoni L, Masheroni D Torresin A, Marcolin R, Fumagalli R, Vesconi S, Rossi G, Rossi F, Baglion Si, Bassi F, Nastri G, Pesenti A. Morphological response to positive end expiratory pressure in acute respiratory failure. Computerized tomography study. Intensive Care Med. 1986;12(3):137-42.
9. East TD, inʼtVeen J C, Pace N, McJames S. Functional residual capacity as a noninvasive indicator of optimal positive end-expiratory pressure. J Clin Monit. 1988 ;4(2):91-8.
10. Kim WH, Hahm TS, Kim JA, Sim WS, Choi DH, Lee EK, Lee SM. Prolonged inspiratory time produces better gas exchange in patientsundergoing laparoscopic surgery: a randomised trial. Acta Anaesthesiol. Scand. 2013; 57 (5): 613-622.
11. Bugedo G, Retamal J, Bruhn A. Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation? Crit Care. 2017; 21: 199.
12. Hatipoglu S, Akbulut S, Hatipoglu F, Abdullayev R. Effect of laparoscopic abdominal surgery on splanchnic circulation: historical developments. World J. Gastroenterol. 2014; 20 (48): 18165-18176.
13. Pirrone M, Fisher D, Chipman D, Imber D A, Corona J, Mietto C, Kacmarek R M, Berra L. Recruitment Maneuvers and Positive End-Expiratory Pressure Titration in Morbidly Obese ICU Patients. Crit Care Med. 2016;44(2):300-7.
14. Artuso D, Wayne M, Cassaro S, Cerabona T, Teixeira J, Grossi R. Hemodynamic Changes During Laparoscopic Gastric Bypass. Arch Surg. 2005;140 (3):289-292. doi:10.1001/archsurg.140.3.289
15. Laffey J G, O'Croinin D, McLoughlin P, Kavanagh B P. Permissive hypercapnia - role in protective lung ventilatory strategies. Intensive Care Med. 2004; 30(3):347-56.
16. Marhong J, Fan E. Carbon dioxide in the critically ill: too much or too little of a good thing? Respir Care. 2014;59(10):1597-605.
17. Борисов А.Е. Видеоэндоскопические вмешательства на органах живота, груди и забрюшинного пространства. СПб.: ЭФА; 2002. 416 с.
评论
浏览:
568
Email this article 