Impact of new methods of respiratory support on postoperative restrictive syndrome and gas exchange after ventral hernias plasty
DOI:
https://doi.org/10.15587/2313-8416.2015.53823Keywords:
postoperative hypoxemia, atelectasis, recruitment maneuver, noninvasive pulmonary ventilation, ventral herniasAbstract
The concept of respiratory support in anesthesiology underwent significant changes for last decade. The aim of these changes was the decrease of frequency of postoperative pulmonary dysfunction development. In the research was considered an impact of the new strategies of respiratory support on the state of external respiration and pulmonary gas exchange in early postoperative period at large and giant ventral hernias plasty.
Methods. 77 patients underwent the prospective clinical examination after nonstrain methods of ventral hernias plasty. Patients receive the standard respiratory support in postoperative period, lung recruitment maneuver (RM) 40/10 and positive end-expiratory pressure (РЕЕР) 7–10 sm. water column, postoperative constant positive airway pressure (СРАР). There were studied the next parameters: oxygen saturation of arterial blood (SpO2), partial oxygen pressure in arterialized capillary blood (PaO2), gradient of carbon dioxide end-expiratory partial pressure in arterialized capillary blood (Р(а-et)CO2)), respiratory volume (RV), forced vital capacity (FVC)of lungs. The Kruskal-Wollis method with Mann-Whitney criterion assessment was used at intergroup analysis. Statistical analysis - STATISTICA AS for Windows (version 5.5).
Results. Statistical analysis demonstrated statistically significant (р<0,05) increase of oxygenation parameters (SpO2 , PaO2), spirogram parameters (RV, FVC), gradient decrease Р(а-et)CO2 in СРАР, RМ+СРАР groups in first 48 hours of postoperative period after large and giant ventral hernias plasty.
Conclusions. Postoperative СРАР and its combination with intraoperative RМ improve the state of oxygenation, decrease the restrictive syndrome in the first 48 hours after large and giant hernias plastyReferences
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