压力控制-容量保证机械通气模式在老年患者后腹腔镜手术中的可行性与安全性

Study on safety of pressure control-volume guarantee ventilation administrated in elderly patients undergoing retroperitoneoscopy

【目的】观察压力控制-容量保证机械通气模式能否安全地用于老年患者后腹膜腹腔镜手术。【方法】将36例拟行择期后腹腔镜手术的老年患者(>60岁)随机分为传统的容量控制组(A组)和压力控制-容量保证组(B组),每组18例,两组机械通气开始后、气腹开始后呼吸参数均调整为一样的数值,观察并记录两组患者在气腹前、气腹后10、30、60、120 min的生命体征、呼吸力学及血气分析等参数的变化。【结果】气腹后两组患者气道峰压、动脉血二氧化碳分压与呼气末二氧化碳分压均有升高,其中A组这三项指标升高更加明显(P<0.05),B组各项参数指标虽有升高,但仍在可接受的临床范围之内。【结论】与传统的容量控制通气模式相比,压力控制-容量保证机械通气模式可以更加安全地用于老年患者后腹腔镜手术。

[ Objective ]To observe whether pressure control-volume guarantee （PCV-VG） ventilation can be administrated safely in patients undergoing retroperitoneoscopy. [ Method ] Thirty- six old patients （60 yrs-） of ASA grading II and III scheduled for elective retroperioneal laparoscopy were randomly allocated into one of two groups to receive a ventilation mode of volume control （VC） group （ Group A） and Pressure Control-Volume Guarantee （PCV-VG） group （Group B）, with 18 cases in each group. The parameters of mechanical ventilation was set in the same of conditions in both two groups when mechanical ventilation was started and after the establishment of pneumoperitoneum. All patients had monitored vital signs, airway peak pressure and mean airway pressure and arterial blood gas analysis before and 10, 30, 60, 120 rain after pneumoperitoneum established.[ Results ]The airway peak pressure, mean airway pressure PaCO2 and PETCO2 had risen significantly in both two groups after peumoeritoneum established, but the change in group A was more than that of in group B （P 〈 0.05）. Although there was a trend of increase in the mean blood pressure and heart rate in group A after peumoeritoneum established, there was no statistically difference with group B（P 〉 0.05）.[ Conclusion ]Compared with traditional volume control ventilation mode, pressure control-volume guarantee can be administrated more safely in elderly patients undergoing retroperitoneoscopy.