压力调节容量控制通气用于腹腔镜胆囊手术的研究

Clinical study of pressure-regulated volume control ventilation mode on laparoscopic cholecystectomy

目的探讨压力调节容量控制通气用于腹腔镜胆囊手术的安全性及临床效果。方法行腹腔镜手术患者80例，随机分为两组。V组为容量控制通气（VCV），P组为压力调节容量控制通气（PRVCV）。分别观察两组在麻醉前（T1），手术开始即气腹时（T2），气腹后10min（T3）、30min（T4）、45min（T5）和手术结束气腹放气后5min（T6）6个时段患者的心率（HR）、平均动脉压（MAP）、气道峰压（PIP）、肺顺应性（CL）和呼气末二氧化碳（PETCO2）以及术后苏醒时间、拔管时间及恶心呕吐发生率。结果两组的各时段HR、MAP相比差异无统计学意义（均P〉0．05）；两组在气腹后PIP和PETCO2各值均明显高于手术开始时（P〈0.01或P〈0．05），气腹后10min（T3）PIP值P组与V组相比差异有统计学意义（P〈0．05）；两组CL在气腹后均明显低于手术开始时（均P〈0．01），但组间差异无统计学意义（均P〉0．05）；两组的术后苏醒时间、拔管时间及恶心呕吐发生率差异无统计学意义（P〉0．05）。结论压力调节容量控制通气用于腹腔镜胆囊手术安全，能有效地降低PIP，防止气压伤，提高氧合，是腹腔镜手术行全身麻醉时一种更好的通气方式。

Objective To study the security and the clinic effect of pressure-regulated volume control ventilation（PRVCV） mode on laparoscopic cholecystectomy. Methods Eighty ASA Ⅰ-Ⅱ laparoscopic cholecystectomy patients of 28 - 56 years old were randomly divided into two groups evenly：group V with volume control ventilation （VCV） and group P with pressure-regulated volume control ventilation（PRVCV）. The anesthesia mechanics（AEON 7500） were continuously measured during operation. HR, MAP, PIP, CL and PETCO2 before and after pneumoperitoneum（T1 ,T2） ,10min（T3） ,30min（T4） ,45min（T5） after pneumoperitoneum and 5min after operation（T6） were recorded. The time to regain consciousness, the time to wipe out tracheal tube, and the incidence of nausea and vomiting were recorded too. Results There were no significant differences in HR,MAP at all time points among the two groups（P 〉 0.05）. PIP and PETCO2 increased significantly after CO2 pneumopefitoneum（ P 〈 0.05 or P 〈 0.01 ）, and PIP was significantly different at T3 time point among the two groups（P 〈 0.05 ）. CL lowered significantly after CO2 pneumoperitoneum（P 〈 0.01 ） and there were no significant differences among the two groups（ p 〉 0. 05）. There were no significant differences in the time to regain consciousness,the time to wipe out tracheal tube,and the incidence of nausea and vomiting after operation between the two groups,either（P〉0.05）.Conclusion The mode of pressure-regulated volume control ventilation（PRVCV） is safe and can lower the PIP level, prevent barotrauma and enhance oxygenation effectively, so it is a better ventilation mode on laparoscopic cholecystectomy during general anesthesia.