容量和压力通气模式在婴幼儿喉罩麻醉中的对比研究

Comparative study of volume and pressure ventilation modes in infant laryngeal mask anesthesia

目的探讨婴幼儿喉罩麻醉中分别使用容量和压力通气模式,对患儿气道压力与血气指标水平的影响。方法将2020年5月至2021年6月茂名市妇幼保健院收治的行喉罩全麻手术的100例婴幼儿按照随机数字表法分为对照组(50例,采取容量通气模式)与观察组(50例,采取压力通气模式)。比较两组患儿麻醉前(T_(0))、气腹后10 min(T_(1))、气腹放气后5 min(T_(2))的气道压力、潮气量、漏气率及血气指标,以及术后24 h不良反应发生情况。结果T_(1)、T_(2)时,观察组患儿气道峰压(Ppeak)、平均气道压(Pmean)水平均显著低于对照组(均P<0.05);与T_(0)相比,T_(1)、T_(2)时观察组患儿吸气潮气量(TV)先升高后降低,漏气率先降低后升高,而观察组T_(1)时吸气TV水平显著高于对照组,漏气率水平显著低于对照组(均P<0.05);与T_(0)相比,T_(1)、T_(2)时两组患儿动脉血二氧化碳分压(PaCO_(2))水平呈先升高后降低,肺泡动脉血氧分压差(A-aDO_(2))水平均呈逐渐升高趋势(均P<0.05);但两组患儿不同时间点动脉血氧分压(PaO_(2))、PaCO_(2)、A-aDO_(2)水平比较,差异均无统计学意义(均P>0.05);观察组患儿不良反应总发生率显著低于对照组(P<0.05)。结论婴幼儿喉罩全麻时应用压力通气模式和容量通气模式,均可维持良好的气道压力,而压力通气模式可进一步保证有效肺通气,降低气道压力及喉罩漏气率,且安全性较高。

Objective To explore the effects of volume and pressure ventilation modes on the airway pressure and blood gas index levels in infant laryngeal mask anesthesia.Methods A total of 100 infants who underwent laryngeal mask anesthesia in Maoming Maternal and Child Health Hospital from May 2020 to June 2021 were divided into the control group(50 cases,adopting volume ventilation mode)and the observation group(50 cases,adopting pressure ventilation mode)according to the random number table method.The airway pressure,tidal volume(TV),air leakage rate and blood gas indexes before anesthesia(T_(0)),10 minutes after pneumoperitoneum(T_(1)),and 5 minutes after pneumoperitoneum deflation(T_(2)),and the occurrence of adverse reactions 24 hours after operation of children were compared between the two groups.Children in both groups were observed for 24 hours after operation.Results At T_(1) and T_(2),the levels of Peak airway pressure(Ppeak),mean airway pressure(Pmean)of children in the observation group were significantly lower than those in the control group(all P<0.05);compared with T_(0),the inspiratory TV of children in the observation group increased first and then decreased from T_(1) to T_(2),and the air leakage first decreased and then increased from T_(1) to T_(2),while the inspiratory TV level in the observation group at T_(1) was significantly higher than that in the control group,and the air leakage rate was significantly lower than that in the control group(allP<0.05);compared with T_(0),the levels of arterial partial pressure of carbon dioxide(PaCO_(2))of children in the two groups increased first and then decreased from T_(1) to T_(2),and the levels of alveolar arterial oxygen partial pressure(A-aDO_(2))increased gradually from T_(1) to T_(2)(all P<0.05);but there was no significant difference in the levels of arterial partial pressure of oxygen(PaO_(2)),PaCO_(2) and A-aDO_(2) between the two groups at different time points(all P>0.05);the total incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Pressure ventilation mode and volume ventilation mode can maintain good airway pressure during infant laryngeal mask anesthesia,and pressure ventilation mode can further ensure effective lung ventilation,reduce airway pressure and laryngeal mask air leakage rate,and which has higher security.