压力支持通气与压力控制通气应用于小儿腹腔镜短小手术的效果比较

Comparison of pressure support ventilation and pressure control ventilation in children receiving short- term minor laparoscopic surgery

目的探讨压力支持通气（PSv）模式在小儿气管内全麻下腹腔镜短小手术的效果。方法收集本院2011年2月至2012年12月择期拟行腹腔镜腹股沟疝修补术患儿60例，年龄3—11岁，体质量14～40妇，美国麻醉师协会（ASA）分级I级，随机分为使用PSV组（s组，n=30）和压力控制通气模式（PCV）组（c组，n=30）。两组患儿静脉注射芬太尼2mg／kg、丙泊酚2mg／kg、琥珀胆碱1．5mg／妇麻醉诱导，插入气管导管。插管成功后，均吸人七氟醚维持麻醉，呼气末七氟醚浓度维持在1．3～1．5MAC（最低肺泡有效浓度）。c组患儿术中以PCV控制呼吸至气管导管拔管期，维持呼气末二氧化碳分压（PETCO2）于35—45mmHg（1mmHg=0．133kPa），患儿出现自主呼吸时以静脉注射顺苯磺酸阿曲库铵（0．1mg／kg）维持肌松。s组患儿以PCV至气管导管拔管期，维持P即c02于35～45mmHg，患儿出现自主呼吸时，使用PSV的通气模式控制呼吸，术中不追加任何肌肉松弛药。两组患儿均在停止气腹时停止吸人七氟醚。分别记录麻醉诱导前（T0）、气管插管完毕（T1）、气腹开始（T2）、气腹5min（T3）、气腹10min（T4）、停止气腹（T5）、术毕（T6）、气管导管拔管时（T7）各时间点时两组患儿平均动脉压（MBP）、心率（HR）的变化。记录手术和气管导管拔管的时间。结果与T0时比较，c组患儿T1～T6时MBP、HR的差异均无统计学意义，T7时HR、MBP明显升高（均P〈0．05）。s组组内比较，患儿T0～T7时MBP、HR的差异均无统计学意义。C组患儿T0-Te时与s组患儿MBP、HR的差异均无统计学意义，T，时c组患儿HR、MBP明显高于S组患儿（均P〈0．05）。C组患儿的气管导管拔管时间比s组患儿长[（23±5）min比（6±2）min，P〈0．05]。结论PSV通气模式无需合用长效肌松药，拔管时间短，拔管时心血管反应轻微，非常适用于小儿腹腔镜短小手术。

Objective To determine the efficacy of pressure support ventilation （PSV） in children receiving short term minor laparoscopic surgery under general anesthesia. Methods Sixty children with American Society of Anesthesiology （ASA） stage I （age： 3-11 years, weight： 14-40 kg） scheduled for laparoscopic hernia repair between February 2011 and December 2012 were randomly assigned to pressure control ventilation （PCV） group （group C, n=30） and PSV group （group S, n--30）, respectively. Anesthesia was induced with fentanyl 2 μg/kg, propofol 2 mg/kg and scoline 1.5 mg/kg. This was followed by endotracheal intubation and maintenance anesthesia with sevoflurane, with the end-expiratory concentration corresponding to 1.3-1.5 minimal alveolar concentration. Children in group C received PCV till extubation, with an end-expiratory partial pressure of carbon dioxide （PETCO2） retained at 35-45 mm Hg （1 mm Hg=0.133 kPa）. This was followed by intravenous injection of cis-atracurium bensylate （0.1 mg/kg） for muscular relaxation when spontaneous breathing commenced. Children in group S were treated with PCV till extubation by maintaining the PETC02 at 35-45 mm Hg. This was followed by translation from PCV to PSV upon initiation of spontaneous breathing. Injection of additional muscle relaxant was spared. Anesthesia with sevoflurane was ceased upon cessation of artificial pneumoperitoneum in both groups. The mean arterial blood pressure （MBP） and heart rate （HR） were recorded before induction of anesthesia （To）, at the end of intubation （T1）, at the commencement of pneumoperitoneum （T2）, at 5 rain following pneumoperitoneum （T3）, at 10 min following pneumoperitoneum （T4） , upon cessation of pneumoperitoneum （T5） , upon cessation of operation （T6） and during extubation （T7） respectively. The time for surgery and tracheal extubation was recorded. Results The difference in MBP and HR between baseline level （To） and Tl- T6 was unremarkable, with exception of significantly increased at T7 in group C （both P〈0.05）. Compared with baseline level （To）, the difference in MBP and HR at all time points （T1-TT） did not reach statistical significance in group S. MBP and HR were not statistically different between the two groups, with exception of markedly increased MBP and HR at T7 in group C compared with group S （both P〈0.05）. Time of extubation in group C was longer compared with group S [ （23±5）min vs （6±2）rain, P〈0.05]. Conclusion Characterized by reduced time to extubation and minor cardiovascular reactions, PSV may waive the need of additional long-acting muscle relaxants and is suitable for children receiving short-term minor laparoscopic surgery.