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直接气道压力测定在腹腔镜胆囊切除术中的临床应用
DIRECT MEASUREMENT OF TRACHEAL PRESSURE IN LAPAROSCOPIC CHOLECYSTECTOMY

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DOI:
作者:
王震虹,王祥瑞
ZHENHONG WANG XIANGRUI WANG
作者单位:
上海仁济医院
Renji Hospital Shanghai Jiaotong University School of medicine
关键词:
腹腔镜 气道压力 直接测压
laparoscopic cholecystectomy tracheal pressure fiber optic pressure transducer
摘要:
目的：比较采用光纤压力传感器（FOPT）直接气道内测压和呼吸机的压力测定在腹腔镜手术中对气道压力测定的不同，评估气道内直接测压的敏感性和有效性，为临床上提供更可靠的气道压检测方法。方法：腹腔镜胆囊切除术的患者，光纤压力传感器插入气管导管内，气腹前、气腹后、体位改变后、术中以及气腹后10分钟分别记录FOPT测定的压力（Ptrac）和麻醉机测定的压力（Pprox），并加以比较。结果：插入FOPT前后Pprox没有显著性改变，气腹前FOPT测得的Ptrac为呼吸机测得的Pprox的66.56%，气腹后FOPT测得的Ptrac为呼吸机测得的Pprox的59.24%，气腹后Pprox和Ptrac均明显增高,体位改变对气道压的影响不明显（ｐ>0.05）,而随着手术时间的延长气道压力增加, Ptrac和Pprox相比变化更显著（ｐ<0.05）。结论：光纤压力传感器可以放置在气道内直接测定气道压力，并且不影响气道内的压力，压力测定对放置的位置要求不高，并且在术中各种因素对气道压力产生影响时光纤压力传感器更加敏感,因此光纤压力传感器测定压力和传统呼吸机压力测定相比更灵敏更准确。
Objective: This study uses fiber optic pressure transducer(FOPT) to measure the tracheal pressure in patients undergoing laparoscopic cholecystectomy, compare it with the pressure measured proximal to the ETT and estimate the validity of the data obtained from the FOPT. It is the main aim that FOPT is a more sensitive and effective method to measure tracheal pressure. Methods: After induction of anesthesia the FOPT was inserted in the ETT. Airway pressure was measured at the anesthetic machine (Pprox) and using FOPT (Ptrac) before insufflation of pneumoperitoneum, after insufflation of pneumoperitoneum (15mmHg, kept constant), after patient tilting, every 10min during the operation and 10 min after reversal of pneumoperitoneum. Results: There is no difference between the Pprox before and after insertion (P>0.05). After positioning the Pprox and Ptrac both increased(p<0.05), Ptrac was lower than Pprox. After patient tilting, both Pprox and Ptrac showed no significant changes (P>0.05). Airway pressure increased significantly with time prolonged, Ptrac was more notable than Pprox（ｐ<0.05）. Conclusion: FOTP can be inserted into ETT to measure airway pressure directly without influence on airway pressure. And any position was available. When pressure changed under due to some facts during operation FOTP was more sensitive than anesthetic machine.

 

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