婴儿腹腔镜手术中两种通气模式的比较

Two modes of mechanical ventilation for laparoscopy in infants

目的观察在婴儿腹腔镜手术全麻期间采用压力控制通气（PCV）和容量控制通气（VCV）对患儿呼吸力学、血气及血流动力学的影响，探讨合理的呼吸管理方式。方法40例择期行腹腔镜手术的婴儿，年龄1～3个月，采用气管插管静吸复合全麻，二氧化碳（CO2）气腹期间，随机接受PCV和VCV二种通气方式，分别于气腹前（T1）、气腹开始后15min（T2）、气腹开始后30min（T3），记录气道峰压（Ppeak）、平均气道压（Pmean）、胸肺顺应性（1ung-thorax compliance，C）等呼吸力学和血流动力学指标的变化，同时于T1、T3时点采集血样进行血气分析。结果CO2气腹后，二组患儿在R、L时点的C较气腹前显著下降（P〈0．05），Ppeak、Pmean及PaCO2显著上升（P〈0．05），气腹期间，VCV组患儿的Ppeak和Pmean明显高于PCV组患儿（P〈0．05），二组患儿之间的PaO2和循环参数无显著性差异（P〉0．05）。结论在小婴儿腹腔镜手术的全麻中，气腹期间应用压力控制模式机械通气，能在相对低的气道压力下提供有效的肺通气，在预防患儿产生肺气压伤方面较VCV更有优势。

Objective To explore rational mode of respiratory management for laparoscopic operations under general anesthesia in infants. Methods Forty infants with the age ranging from 1 to 3 months who were scheduled for elective laparoscopy were enrolled in this study. The infants were incubated and anesthetized with intravenous-inhalation anesthesia. During CO2 pneumoperitoneum, infants were randomly ventilated by pressure controlled ventilation（PCV） or volume controlled ventilation （VCV）. Peak airway pressure （Ppeak）, mean airway pressure （Pmean）, thorax-lung compliance （C） and hemodynamic parameters of the patients were monitored before pneumoperitoneum（T1）, 15 and 30 minutes during CO2 pneumoperitoneum（T2 and T3）. Blood samples for blood gas analysis were taken at T1 and T3. Results Compared with the values at T1, the thorax-lung compliance （C） at T2 and T3 decreased significantly in both groups （P〈0.05）, while Ppeak, Pmean and partial pressure of carbon dioxide in artery （PaCO2） increased significantly （P〈0.05）. Ppeak and Pmean in the VCV group were significantly higher than those in the PCV group （P〈0.05）. Partial pressure of oxygen in artery （PaO2） and hemodynamic parameters were similar between the two groups of patients after pneumoperitoneum, with no significant difference （P〉0.05）. Conclusions During laparoscopy under general anesthesia in young infants, PCV can provide effective mechanical ventilation with relatively lower peak inspiratory airway pressure, which had more superiority than VCV in preventing ventilator-induced lung injury.