PCV-VG和VCV模式对Trendelenburg体位下腹腔镜手术通气功能的影响研究

doi:10.3969/j.issn.1009-976X.2020.04.024

摘要/Abstract

摘要： 目的研究在Trendelenburg体位下腹腔镜手术中,压力控制容量保证通气（PCV-Vg）和容量控制通气（VCV）对气道压力和呼吸循环指标的影响。方法 40例在头低脚高位行择期腹腔镜手术的ASAⅠ级和Ⅱ级的患者。采用随机数字表法分为VCV组（n=20）和PCV-VG组（n=20）。麻醉诱导后,两种通气方式下,目标潮气量（VT）为8 mL/kg。计算峰值和平均吸气压力、动态顺应性、呼气VT、氧合指数和生理无效腔,仰卧位下麻醉诱导后5 min T1处记录,气腹稳定后5 min为T2,气腹30°头低脚高位后的15 min和60 min分别记为T3和T4。结果 PCV-VG组吸气峰压明显低于VCV组,动态顺应性明显高于VCV组。结论在Trendelenburg体位下腹腔镜手术的患者中,PCV-VG能够提供比VCV更低的峰值吸气压力和更大的动态顺应性,对肺通气可能有一定的保护作用。

关键词: PCV-VG, Trendelenburg体位, 机械通气, 腹腔镜手术

Abstract: Objective To study the effects of pressure-controlled volume-assured ventilation （PCV-Vg） and volume-controlled ventilation （VCV） on airway pressure and respiratory cycle indexes during laparoscopic surgery in Trendelenburg. Methods Forty patients with ASAI and II who underwent elective laparoscopic surgery at the low head and high position were enrolled. The random number table method was divided into VCV group （n=20） and PCV-VG group （n=20）. After induction of anesthesia, the target tidal volume （VT） was 8 ml/kg in both ventilation modes, and the respiratory rate was adjusted to avoid hypercapnia. Calculate the peak and average inspiratory pressure, dynamic compliance, expiratory VT, oxygenation index and physiological ineffective cavity. Recorded at T1 5 minutes after induction of anesthesia in supine position, T2 after 5 minutes of pneumoperitoneum stabilization, 30° of pneumoperitoneum 15 min and 60 min after the low foot high are recorded as T3 and T4, respectively. Results The peak inspiratory pressure of PCV-VG group was significantly lower than that of VCV group, and the dynamic compliance was significantly higher than that of VCV group. Conclusion In patients undergoing laparoscopic surgery under Trendelenburg, PCV-VG was able to provide lower peak inspiratory pressure and greater dynamic compliance than VCV, and may have some protective effects on lung ventilation.

Key words: laparoscopic surgery, mechanical ventilation, trendelenburg position, PCV-VG

中图分类号:

吴耀滨, 谭艺平, 朱海滨, 邓秋红, 叶凤卿. PCV-VG和VCV模式对Trendelenburg体位下腹腔镜手术通气功能的影响研究[J]. 岭南现代临床外科, 2020, 20(04): 512-516.

WU Yao-bin, TAN Yi-ping, ZHU Hai-bin, DENG Qiu-hong, YE Feng-qing. PCV-VG and VCV mode correct trendelenburg posture study on the effect of laparoscopic ventilatory function[J]. Lingnan Modern Clinics in Surgery, 2020, 20(04): 512-516.

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