压力控制通气模式在合并轻度阻塞性通气功能障碍老年患者腹腔镜胆囊手术中的通气效果

Effect of PCV on mild obstructive ventilation dysfunction in elderly patients undergoing laparoscopic cholecystectomy

目的评价压力控制通气(PCV)模式用于合并轻度阻塞性通气功能障碍的老年患者行腹腔镜胆囊切除术中的通气效果。方法选择择期拟行腹腔镜胆囊切除术患者40例,男23例,女17例,年龄65~75岁,ASAⅡ或Ⅲ级,合并轻度阻塞性通气功能障碍,BMI 18.5~23.9kg/m^2,采用随机数字表法,均分为两组:容量控制通气(VCV)组(V组)和PCV组(P组)。新鲜气流量均为2L/min,FiO_260%,VT_8~12ml/kg(P组调整吸气压),I∶E 1∶2,RR 12~16次/分。调整通气参数维持PET_CO2 35~45mm Hg。直至手术结束后气管导管拔除期间两组均分别维持以上通气模式及呼吸参数。于气管插管后5min(气腹前)(T_1)、气腹开始后30min(T_2)、气腹结束后10min(T_3)时记录气道峰压(Ppeak)、气道平台压(Pplat)、吸气阻力(Raw)和动态肺顺应性(Cdyn),采集桡动脉和混合静脉血行血气分析,计算氧合指数(PaO_2/FiO_2)、呼吸指数(RI)、死腔通气率(VD/VT_)和肺内分流率(Qs/Qt)。记录拔管时间、复苏室停留时间和拔管后2h内高碳酸血症、低氧血症等不良反应的发生情况。结果与V组比较,T_1~T_3时P组Ppeak、Pplat和Raw明显降低,Cdyn、PaO_2/FiO_2明显升高,RI、VD/VT_、Qs/Qt和拔管后低氧血症发生率明显降低(P<0.05)。两组拔管时间、复苏室停留时间及高碳酸血症发生率差异无统计学意义。结论 PCV模式可安全用于合并轻度阻塞性通气功能障碍的老年腹腔镜胆囊切除术患者,其通气效果好,低氧血症发生率降低。

Objective To evaluate effect and safety of pressure-controlled ventilation（PCV）during laparoscopic cholecystectomy in aged patients with mild obstructive ventilation dysfunction.Methods Forty elderly patients with mild obstructive ventilatory dysfunction,aged 65 to 75years,falling catergary of ASA Ⅱ or Ⅲ,with body mass index of 18.5-23.9kg/m^2,undergoing elective laparoscopic cholecystectomy were randomly divided into two groups（n=20each）：PCV group（group P）and volume-controlled ventilation（VCV）group（group V）.Fresh gas flow was set at 2L/min,FiO_260%,VT8^（-1）2ml/kg,I∶E 1∶2,respiratory rate 12^（-1）6,P_（ET）CO_2 was maintained at 35-45 mm Hg in both groups.From the end of surgery to extubation,two groups were respectively maintained separate ventilation mode and respiratory paramaters.Airway peak pressure（Ppeak）,airway plateau pressure（Pplat）,and airway resistance（Raw）,dynamic lung compliance（Cdyn）and P_（ET）CO_2 were measuredat 5min after intubation（before pneumoperitoneum）（T_1）,30 min after pneumoperitoneum（T_2）,10 min after the end of pneumoperitoneum（T_3）.The radialartery and mixed venous blood was sampled for blood gasanalysis.Oxygenation index（PaO_2/FiO_2）,respiratory index（RI）,dead space ventilation（VD/VT）and the pulmonary shunt fraction（Qs/Qt）were calculated.Extubation time and extubation associated complications 2hwere recorded.Results Compared with group V,Ppeak,Pplatand Raw,RI,VD/VTand Qs/Qt were decreased at T_1-T_3,and Cdyn and PaO_2/FiO_2 were increased at T_1-T_3,and the incidence of hypoxemia was decreased within 2 hafter extubation was statistically significant difference in group P（P0.05）.There were no statistically sig-nificant differences in extubation time,the recovery time and the incidence of hypercapniabetween the two groups.Conclusion PCV can be used in aged patients with mild obstructive ventilation dysfunction undergoing laparoscopic cholecystectomy for its good ventilation effect and less complications.