压力控制容量保证通气模式在阻塞性睡眠呼吸暂停综合征肥胖患者中的应用

Application of pressure-controlled ventilation-volume guaranteed in obese patients with obstructive sleep apnea syndrome

目的:探讨压力控制容量保证通气(PCV-VG)模式应用于阻塞性睡眠呼吸暂停综合征(OSAS)肥胖患者悬雍垂腭咽成型术中的临床有效性。方法:择期全身麻醉下行悬雍垂腭咽成型术的OSAS肥胖患者(BMI≥30 kg/m^2)40例,随机分为容量控制通气组(V组,20例)和压力控制容量保证通气组(P组,20例)。记录麻醉诱导未吸氧前(T_0)、气管插管后30 min(T_1)和1 h(T_2)、拔除气管导管后30 min(T_3)的心率(HR)、平均动脉压(MAP)以及动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)值,同时计算T_1、T_2时点的气道峰压(P_(peak))、气道阻力(R_(aw))、胸肺顺应性(C_L)、氧合指数(OI)和呼吸指数(RI),观察比较术后恢复情况。结果:2组患者麻醉前情况和术后恢复情况无明显差异。与V组比较,P组在T_1、T_2时PaCO_2、P_(peak)、R_(aw)以及T_1~T_3时RI降低(P<0.05),在T_1、T_2时C_L以及T_1~T_3时PaO_2、OI升高(P<0.05),两组在各时点的HR、MAP差异无统计学意义。结论:与容量控制通气模式相比,PCV-VG能够有效提高OSAS肥胖患者的胸肺顺应性,降低吸气压力和气道阻力,减少肺内分流,有利于改善动脉氧合和气体交换。

Objective To explore the clinical effectiveness of pressure?controlled ventilation?volume guar?anteed(PCV?VG)in obese patients with obstructive sleep apnea syndrome(OSAS)during uvulopalatopharyngo?plasty.Methods40obese patients(BMI≥30kg/m2)with OSAS scheduled for uvulopalatopharyngoplasty undergeneral anesthesia were randomly divided into two groups of volume?controlled ventilation(group V,n=20)andpressure?controlled ventilation?volume guaranteed(group P,n=20).The heart rate(HR),mean arterial pressure(MAP),arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbondioxide(PaCO2)wererecorded before induction of anesthesia without oxygen inhalation(T0),30min(T1)and1h(T2)after trachealintubation,and30min after extubation(T3).The peak airway pressure(Ppeak),airway resistance(Raw),thoraciccompliance(CL),oxygenation index(OI)and respiratory index(RI)were also calculated at T1and T2underobservation of recovery.Results There were no obvious differences between the two groups of patients beforeanesthesia and after recovery.Compared with the group V,PaCO2,PPEAK,Raw at T1,T2and RI at T1~T3of thegroup P decreased(P<0.05),while CL at T1,T2and PaO2,OI at T1~T3increased(P<0.05).There were no sig?nificant differences in HR,MAP at the above time points.Conclusions Compared with volume?controlled venti?lation,PCV?VG can effectively enhance thoracic compliance,lower inspiratory pressure and airway resistance,anddecrease intrapulmonary shunt,which is conductive to improve arterial oxygenation and gas exchange in obesepatients with OSAS.