国际麻醉学与复苏杂志   2018, Issue (10): 6-6
    
压力控制容量保证通气模式对妇科腹腔镜手术患者 呼吸力学的影响
白洁, 马磊, 孟丽华, 刘鸿涛, 张蓬勃1()
1.西安交通大学第二附属医院
Effect of pressure-controlled ventilation-volume guaranteed mode on respiratory mechanics in gynecologic laparoscopic surgery
 全文:
摘要:

目的 比较全身麻醉下妇科腹腔镜手术患者应用压力控制容量保证通气(pressure?蛳controlled ventilation?蛳volume guaranteed, PCV?蛳VG)模式和容量控制通气(volume?蛳controlled ventilation, VCV)模式对术中血流动力学、血气分析、呼吸力学指标的影响。 方法 择期行妇科腹腔镜手术的患者40例,采用随机数字表法分为两组(每组20例): PCV?蛳VG组和VCV组。记录麻醉诱导前(T0)、气管插管后10 min(T1)和气腹低头位后40 min(T2)、气腹解除平卧位后5 min(T3),清醒拔管后5 min(T4)的HR、MAP,记录并计算T1、T2、T3时的PaO2、PaCO2、气道峰压(the peak airway pressure, Ppeak)、气道平台压(plateau pressure, Pplat)、肺动态顺应性(thoracic compliance, Cdyn)。 结果 两组患者T2时PaO2低于T1、T3(P<0.05),组间差异无统计学意义(P>0.05);两组患者T2时Ppeak、Pplat高于T1、T3,Cdyn低于T1、T3(P<0.05);PCV?蛳VG组T2时Ppeak、Pplat低于VCV组,Cdyn高于VCV组(P<0.05)。两组患者各时点HR、MAP差异无统计学意义(P>0.05)。 结论 与VCV比较,PCV-VG能够有效降低妇科腹腔镜手术患者Ppeak和Pplat,提高Cdyn,提供足够的动脉氧合,降低机械性肺损伤的风险。

关键词: 容量控制通气; 压力控制容量保证通气; 妇科腹腔镜手术; 呼吸力学
Abstract:

Objective To explore the effects of pressure-controlled ventilation-volume guaranteed(PCV-VG) mode on hemodynamics,blood gas analysis and respiratory mechanics in patients undergoing gynecologic laparoscopic surgery, compared with volume-controlled ventilation(VCV) mode. Methods Forty patients undergoing gynecologic laparoscopic surgery were randomly allocated into 2 groups(n=20): group PCV-VG and group VCV. The HR, MAP were recorded before induction of anesthesia without oxygen inhalation (T0), 10 min after tracheal intubation (T1),40 min after pneumoperitoneum in trendelenburg position (T2), 5 min after closing pneumoperitoneum in supine position(T3) and 5 min after extubation(T4). PaO2, PaCO2, the peak airway pressure (Ppeak), plateau pressure (Pplat) and thoracic compliance (Cdyn) were measured at T1, T2, T3. Results The PaO2 at T2 was significantly lower than that at T1 and T3 in both groups (P<0.05), but did not differ between group PCV-VG and VCV (P>0.05). There were higher Ppeak and Pplat and lower Cdyn at T2 than those at T1 and T3 in both groups (P<0.05). In addition, group PVC-VG showed lower Ppeak, Pplat and higher Cydn in at T2, compared to those in group VCV (P<0.05). There was no significant difference in either HR or MAP at all recording time points between the two groups(P>0.05). Conclusions In comparison with VCV, PCV-VG can effectively enhance thoracic compliance, lower the airway peak pressure and plateau pressure, improve arterial oxygenation and gas exchange, and decrease the risk of lung injury after mechanical ventilation in patients undergoing gynecologic laparoscopic surgery.

Key words: Volume-controlled ventilation; Pressure-controlled ventilation-volume guaranteed; Gynecologic laparoscopic surgery; Respiratory mechanics