medecolМедицина и экологияMedicine and ecology2305-60452305-6053Карагандинский медицинский университет10.59598/ME-2305-6045-2024-113-4-29-42medecol-797Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSВлияние пневмоперитонеума на дыхательную систему: осложнения и стратегии менеджмента в лапароскопической хирургииThe impact of pneumoperitoneum on respirtory system: complications and managment strategies in laparoscopic surgeryЕсенбаеваГ. А.YessenbayevaG. A.

010000, г. Астана, ул. Керей-Жанибек хандар, 3

Gulfairus Abdimazhitkyzy Yessenbayeva

010000, Astana, 3, Kerei-Zhanibek khandar str.

nrocastana@gmail.comКлюевД. А.KlyuyevD. A.

100008, г. Караганда, ул. Гоголя, 40

100008, Karaganda, 40, Gogol St.

info@qmu.kzМолотов-ЛучанскийВ. Б.Molotov-LuchanskiyV. B.

100008, г. Караганда, ул. Гоголя, 40

100008, Karaganda, 40, Gogol St.

info@qmu.kzШалекеновС. Б.ShalekenovS. B.

010000, г. Астана, ул. Керей-Жанибек хандар, 3

100008, Karaganda, 40, Gogol St.

info@qmu.kzЯрошецкийА. И.YaroshetskiyA. I.

119048, Москва, ул. Трубецкая, д. 8, стр. 2

119048, Moscow, 8, Trubetskaya St., p. 2

rectorat@staff.sechenov.ruНациональный научный онкологический центрКазахстанNational Research Oncology CenterKazakhstanНАО «Медицинский университет Караганды»КазахстанKaraganda medical university NC JSCKazakhstanНациональный научный онкологический центрКазахстанKaraganda medical university NC JSCKazakhstanПервый Московский государственный медицинский университет имени И. М. СеченоваРоссияSechenov First Moscow State Medical UniversityRussian Federation202421012025042942Copyright © Есенбаева Г.А., Клюев Д.А., Молотов-Лучанский В.Б., Шалекенов С.Б., Ярошецкий А.И., 20242024Есенбаева Г.А., Клюев Д.А., Молотов-Лучанский В.Б., Шалекенов С.Б., Ярошецкий А.И.Yessenbayeva G.A., Klyuyev D.A., Molotov-Luchanskiy V.B., Shalekenov S.B., Yaroshetskiy A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medecol.qmu.kz/jour/article/view/797

Лапароскопическая хирургия, являющаяся основой современной хирургической практики, привносит революционные изменения в традиционные методы хирургического вмешательства за счет использования минимально инвазивных процедур. Однако этот инновационный подход ставит перед медицинским сообществом сложные задачи, особенно в области управления дыханием, что требует глубокого понимания его физиологических последствий. Пневмоперитонеум, неотъемлемая составляющая лапароскопической хирургии, предполагает инсуфляцию брюшной полости углекислым газом (CO2) для создания подходящего рабочего пространства. Однако это может приводить к физиологическим адаптациям, оказывающим отрицательное влияние на респираторную систему. Изменения, такие как повышение пикового инспираторного давления, снижение динамической податливости дыхательной системы и развитие интраоперационного ателектаза, подчеркивают сложное взаимодействие между пневмоперитонеумом и физиологией дыхания.В свете этих проблем положительное давление в конце выдоха выступает важным инструментом для смягчения негативного влияния пневмоперитонеума на механику дыхания и газообмен. Поддерживая проходимость дыхательных путей и предотвращая альвеолярный коллапс во время выдоха, положительное давление в конце выдоха помогает противостоять снижению функциональной остаточной емкости, связанной с повышенным внутрибрюшным давлением. Кроме того, положительное давление в конце выдоха служит для оптимизации рекрутирования легких, тем самым улучшая вентиляционно-перфузионное соотношение и повышая оксигенацию.Искусственная вентиляция легких во время лапароскопических операций сама по себе может потенциально усугублять повреждение легких. Применение протективных стратегий вентиляции легких, таких как низкий дыхательный объем легких в сочетании с положительным давлением в конце выдоха, являются доказанными компонентами для снижения вентилятор-ассоциированного повреждения легких и послеоперационных легочных осложнений. Оптимальное применение этих стратегий остается предметом постоянных споров, что подчеркивает необходимость персонализированных подходов, учитывающих особенности пациентов и хирургические условия.

Laparoscopic surgery, a cornerstone of contemporary surgical practice, revolutionizes traditional surgical techniques by employing minimally invasive procedures. However, this innovative approach poses intricate challenges, particularly in respiratory management, necessitating a comprehensive understanding of its physiological implications. Pneumoperitoneum involves insufflating the abdominal cavity with carbon dioxide (CO2) to create a suitable working space. The introduction of CO2 into the peritoneal cavity elevates intra-abdominal pressure, prompting physiological adaptations that compromise respiratory function. These alterations, including increased peak inspiratory pressure, decreased dynamic respiratory system compliance, and the promotion of intraoperative atelectasis, underscore the intricate interplay between pneumoperitoneum and respiratory physiology.Amidst these challenges, positive end-expiratory pressure emerges as a crucial intervention for mitigating the adverse effects of pneumoperitoneum on respiratory mechanics. By maintaining airway patency and preventing alveolar collapse during expiration, positive end-expiratory pressure helps counteract the reduction in functional residual capacity associated with elevated intra-abdominal pressure. Additionally, positive endexpiratory pressure serves to optimize lung recruitment, thereby improving ventilation-perfusion matching and enhancing oxygenation.Mechanical ventilation during laparoscopic procedures further complicates respiratory management, potentially exacerbating lung injury. The application of protective lung ventilation strategies, such as low tidal volume combined with judicious positive end-expiratory pressure titration, represents a cornerstone in mitigating ventilator-induced lung injury and reducing postoperative pulmonary complications. However, the optimal implementation of these strategies remains a subject of ongoing debate, highlighting the need for personalized approaches tailored to individual patient characteristics and surgical contexts.Understanding the pivotal role of positive end-expiratory pressure in mitigating the adverse respiratory effects of pneumoperitoneum underscores its importance as a cornerstone intervention in laparoscopic surgery. By optimizing positive end-expiratory pressure levels based on patient characteristics and procedural requirements, healthcare practitioners can effectively mitigate the risk of pulmonary complications and enhance surgical outcomes.

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The authors declare that there are no conflicts of interest present.