新生儿腹腔镜手术中两种呼吸模式探讨

A study of two modes of mechanical ventilation during laparoscopy in neonates

目的探讨腹腔镜手术二氧化碳气腹期间采用定压通气(PCV)和定容通气(VCV)对患儿呼吸力学及血流动力学的影响。方法50例择期行腹腔镜手术的新生儿,按照麻醉中机械通气方式分成PCV组(n=25)和VCV组(n=25),气腹过程中通过调节吸气压力(PCV组)或潮气量(VCV组)使呼气末二氧化碳分压(PETCO2)稳定在(45±1)mmHg。于气腹开始前(T1)、开始后15min(T2)和30min(T3)记录气道峰压(Ppeak)、平均气道压(Pmean)、胸肺顺应性(C)等呼吸力学和血流动力学指标,同时采集动脉血进行血气分析。结果两组在T2、T3时点的C均较气腹前显著下降(P<0.05),Ppeak、Pmean及动脉血二氧化碳分压(PaCO2)显著上升(P<0.05),两组之间的PaCO2和循环参数差异无统计学意义(P>0.05),VCV组Ppeak和Pmean明显高于PCV组(P<0.05)。结论在新生儿腹腔镜手术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容量控制模式更有优势。

Objective To explore adequate respiratory management mode,the effects of pressure controlled ventilation（PCV）and volume controlled ventilation（VCV）on respiratory mechanics,blood gas analysis and hemodynamics were observed in laparoscopy during CO2 pneumoperitoneum in neonates.Methods 50 neonates scheduled for elective laparoscopy were enrolled in this study.The neonates were randomly ventilated using PCV（PCV group,n=25）or VCV（VCV group,n=25）,PETCO2 were set in level of（45±1）mm Hg by adjusting the ventilator during CO2 pneumoperitoneum.Peak airway pressure（Ppeak）,mean airway pressure（Pmean）,thorax-lung compliance（C）and hemodynamic parameters of the patients were monitored before CO2 pneumoperitoneum（T1）,starting pneumoperitoneum 15（T2） and 30（T3） minutes.Blood samples were taken and blood gases were ananlyzed at the same time.Results Compared with the values thorax-lung compliance（C）at T2 and T3 decreased significantly both in two groups（P〈0.05）.Ppeak,Pmean and partial pressure of carbon dioxide in artery（PaCO2）was increased significantly（P〈0.05）.PaCO2 and hemodynamic parameters were similar between the two groups（P〉0.05）.Ppeak and Pmean in the VCV group were significantly higher than in the PCV group（P〈0.05）at T2 and T3.Conclusions During laparoscopy under general anesthesia in neonates,using PCV offers lower peak inspiratory airway pressure,while maintaining efficient ventilation,PCV appeared to be superior to VCV in preventing ventilator-induced lung injury.