压力控制容量保证通气模式在腹腔镜胆囊切除手术中的应用

Application of pressure controlled ventilationvolume guaranteed during Iaparoscopic cholecystectomy

目的观察压力控制容量保证(pressure control with volume guarantee,PC-VG)通气模式对腹腔镜胆囊切除手术患者循环和通气功能的影响.方法选择择期行腹腔镜胆囊切除手术的患者60例,美国麻醉医师协会分级Ⅰ-Ⅱ级,随机分为2组(n=30):P组(PC-VG模式通气组)和V组(容量控制通气组).观察2组患者气管插管后(T_0)、气腹建立后10 min(T_1)、20 min(T_2)、胆囊切除后(T_3)和手术结束(T_4)时的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、潮气量(tidal volume,TV)、分钟通气量(minute volume,MV)、气道峰压(peak airway pressure,Ppeak)、呼气末二氧化碳分压(end-tidal carbon dioxide pressure,P_(ET)CO_2)、肺顺应性(lung compliance,C_L)和气道阻力(airway resistance,Raw).结果2组患者各时间点MAP、HR、RR、TV、MV、Ppeak和P_(ET)CO_2比较差异均无统计学意义(均P>0.05);与同组T_0时比较,2组患者其余各时间点Ppeak和Raw明显升高,C_L明显降低,差异有统计学意义(P<0.05);与V组相比,P组患者T_1-T_4时间点Raw明显降低,C_L明显升高,差异有统计学意义(P<0.05).结论PC-VG通气模式应用于腹腔镜胆囊切除手术能够维持循环功能稳定,并提高患者C_L,减小气道阻力,降低Ppeak,有利于改善患者的通气功能.

AIM To observe the effect of pressure controlled ventilation-volume guaranteed（PCV-VG） on circulatory and respiratory function in patients undergoing laparoscopic cholecystectomy.METHODS Sixty American Society of Anesthesiologists grade I or II patients scheduled for elective laparoscopic cholecystectomy were randomly allocated into either group P（n = 30） or group V（n = 30）.Patients in group P received PCVVG,and those in group V received volumecontrolled ventilation.Data recorded included mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）,tidal volume（TV）,minute volume（MV）,peak airway pressure（Ppeak）,end-tidal carbon dioxide pressure（PETCO2）,lung compliance（CL） and airway resistance（Raw）.Each of the measures above was recorded at intubation（T0）,10 min（T1）and 20 min（T2） after insufflation,the time after the gallbladder was excised and removed（T3）,and the end of the surgery（T4）.RESULTS There was no significant difference in MAP,HR,RR,TV,MV,Ppeak or PETCO2 at all time points between the two groups（P〉0.05）.In both groups,compared with baseline values at T0,Ppeak and Raw were significantly increased at T1-T4,while CL was significantly decreased（P〈0.05）.At T1T4,compared with group V,Raw was significantly lower while CL was significantly higher in group P（P〈0.05）.CONCLUSION PCV-VG can maintain circulation stability,improve lung compliance,and reduce Raw and Ppeak during laparoscopic cholecystectomy.