Влияние пневмоперитонеума на дыхательную систему: осложнения и стратегии менеджмента в лапароскопической хирургии

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.

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