腹腔镜下胆囊切除术中不同通气模式对气道峰压和动脉二氧化碳分压影响的比较

Variation of pneumodynamics between VCV and PCV under laparoscopic cholecystectomy

目的:比较腹腔镜胆囊切除术中不同通气模式对气道峰压和动脉血二氧化碳分压的影响,并筛选合适的通气模式和参数。方法:选择腹腔镜下行胆囊切除术的择期手术病人100例,ASAⅠ或Ⅱ级。随机分成5组(V、P1、P2、P3、P4组),每组各20例,各组均设置分钟通气量为100ml/kg。V组为容量控制模式(VCV),呼吸频率为16次/min;P1～P4组为压力控制模式(PCV),频率分别为12、14、16、18次/min。监测气腹前和气腹后20min的气道峰压(Ppeak)、动脉血二氧化碳分压(PaCO2)。结果:①气腹后20min,V、P1、P2、P3、P4五组的PaCO2值较气腹前增高,差别有统计学意义(P<0.05)。②气腹后20min,V组和P3组的PaCO2增加值较P1、P2、P4组减少,差别有统计学意义(P<0.05)。③气腹后20min,V、P1、P2、P3、P4五组的Ppeak值较气腹前增高,差别有统计学意义(P<0.05)。④气腹后20min,P3组的Ppeak值较V组低,差别有统计学意义(P<0.05)。结论:腹腔镜胆囊切除手术中,分钟通气量为100ml/kg,呼吸频率设置在16次/min时,压力控制模式与相同分钟通气量和呼吸频率下的容量控制模式比较,在保证了患者正常通气的前提下,可以维持更低的气道压力。

Objective：To compare the effects of different breath pattern on pneodynamics and arterial blood gas in laparoscopic cholecystectomy under general anesthesia and to determine the favorable breath mode and aeration parameter.Methods：One hundred patients of ASA grade ⅠorⅡ undergone selective cholecystectomy were randomized into five groups（V,P1,P2,P3,P4,n=20）,with ventilation volume established at 100 ml/kg/min.Group V received volume controlled ventilation （VCV） and the breath frequency was set at 16 times per minute,and groups P1 to P4 were managed by pressure controlled ventilation （PCV）with breath frequency at 12,14,16 or 18 times per minute,respectively.Peak airway pressure （Ppeak） and arterial partial pressure of carbon dioxide （PaCO2） were monitored before aeroperitoneum and 20 minutes after aeroperitoneum.Results：Ppeak was increased 20 minutes after aeroperitoneum in all groups.Similarly,PaCO2 ascended 20 min after aeroperitoneum as compared with the groups of P1,P2 and P4.No distinct variation was seen in group V and P3 with regard to PaCO2,but Ppeak was significant lower in group P3 than that of group V.Conclusion：In laparoscopic cholecystectomy,when setting the ventilation by 100 ml/kg for per minute and breathing frequency at 16 times/min,relatively lower airway pressure can be obtained considering normal ventilation.