容量和压力通气模式在婴儿纤支镜治疗中的对比研究

Volume control versus pressure control ventilation during fiberoptic bronchoscopy in infants

目的本研究通过比较容量和压力两种不同通气模式下行婴儿纤支镜治疗的效果,了解纤支镜在婴幼儿反复或持续性喘息中的治疗价值。方法选择在全麻下择期行纤支镜治疗的手术患儿80例,随机分为容量控制通气模式组(VCV)和压力控制通气模式组(PCV),每组40例。对比两组患儿不同治疗时间点的心率(HR)、平均动脉压(MAP)、SpO2、PETCO2,实际潮气量(VT)、气道峰压(Ppeak)、平均气道压(Pmean)、计算漏气率、治疗开始后30 min的氧分压(PaO2)及二氧化碳分压(PaCO2),记录术后不良反应。结果与VCV组T1~T3时相比较,PCV组的Ppeak[(19.4±2.3)vs.(21.2±1.4)]、Pmean[(9.6±2.0)vs.(11.1±1.2)]、漏气率[(27.7±2.8)vs.(29.5±1.7)]明显降低(P<0.05)。PCV组T3时VT值明显高于VCV组[(54.4±4.8)vs.(51.6±3.1),P<0.05]。与VCV组相比,PCV组胃胀气和术后恶心的发生率明显更低(5.0%、5.0%vs.25.0%、15.0%,P<0.05)。两组患儿PaO2、PaCO2、HR、MAP、SpO2、PETCO2差异均无统计学意义(P>0.05)。结论喉罩全麻下行婴儿纤支镜治疗,压力控制通气可在相对低的气道压力下提供有效的肺通气,其预防高气道压及术后不良反应较容量控制通气更有优势。

ObjectiveTo compare the effects of fiberoptic bronchoscopy in two different ventilation modes,volume and pressure,and the value of fiberoptic bronchoscopy in the treatment of repeated or persistent wheezing in infants.Methods Eighty patients who underwent elective fiberoptic bronchoscopy under general anesthesia were randomly divided into volume control ventilation mode group(VCV group,n=40)and pressure control ventilation mode group(PCV group,n=40).Heart rate(HR),mean arterial pressure(MAP),SpO2,PET-CO2,actual tidal volume(VT),peak airway pressure(Ppeak),mean airway pressure(Pmean),calculation werecompared between the two groups at different treatment time points.The air leak rate,the partial pressure of oxy-gen(PaO2)and the partial pressure of carbon dioxide(PaCO2)30 minutes after the start of treatment were recorded,and postoperative adverse reactions were recorded.ResultsCompared with t1-t3 in VCV group,Ppeak[(19.4±2.3)vs.(21.2±1.4)],Pmean[(9.6±2.0)vs.(11.1±1.2)]and air leakage rate[(27.7±2.8)vs.(29.5±1.7)]in PCV group were significantly decreased(P<0.05).At T3,the VT value of PCV group was significantly higher than that of VCV group[(54.4±4.8)vs.(51.6±3.1),P<0.05].Compared with the VCV group,the incidence of flatulence and postoperative nausea in the PCV group was significantly lower(5.0%,5.0%vs.25.0%,15.0%,P<0.05).There were no significant differences in PaO2,PaCO2,HR,MAP,SpO2 and PETCO2 between the two groups(P>0.05).ConclusionsFor general anesthesia with laryngeal mask during fiberoptic bronchoscopy in infants,pressure control ventilation could provide effective lung ventilation at relatively low airway pressure,and its prevention of high airway pressure and postoperative adverse reactions has advantages over volume control ventilation.