不同机械通气模式对老年喉罩全麻腹腔镜手术术中呼吸参数的影响

Effects of different mechanical ventilation modes on intraoperative respiratory parameters in elderly patients undergoing laparoscopic surgery with laryngeal mask general anesthesia

目的探析压力控制通气(PCV)联合呼气末正压(PEEP)机械通气与容量控制通气(VCV)联合PEEP机械通气在老年喉罩全麻腹腔镜手术患者中的应用效果。方法选择2020年2月至2021年1月在我院手术室行喉罩全麻腹腔镜手术的300例老年患者为研究对象,按照随机数字表法将其分为对照组和观察组,各150例。对照组行VCV联合PEEP机械通气模式,观察组行PCV联合PEEP机械通气模式。比较两组患者进入手术室后5 min(T_(0))、行气管插管VCV通气后5 min(T_(1))、建立人工气腹后5 min(T_(2))、建立人工气腹后35 min(T_(3))、人工气腹结束后(T_(4))的呼吸力学指标、血气分析指标、肺损伤指标及术后呼吸系统并发症发生情况。结果T_(1)、T_(2)、T_(3)、T_(4)时,观察组的潮气量(Vt)、动态肺顺应性(Cdyn)高于对照组,气道平台压(Pplat)、气道峰压(Ppeak)低于对照组(P<0.05)。T_(1)、T_(2)、T_(3)、T_(4)时,两组的呼气末二氧化碳分压(PETC02)比较,差异无统计学意义(P>0.05)。T_(1)、T_(2)、T_(3)、T_(4)时,观察组的动脉血氧分压(Pa02)、氧合指数(OI)高于对照组,动脉血二氧化碳分压(PaC02)低于对照组(P<0.05)。T_(1)、T_(4)时,观察组的呼吸指数(RI)低于对照组(P<0.05)。T_(1)、T_(2)、T_(3)、T_(4)时,观察组的白细胞介素-6(IL-6)、可溶性晚期糖基化终末产物受体(sRAGE)水平低于对照组(P<0.05)。观察组的术后呼吸系统并发症总发生率为4.67%,低于对照组的12.67%(P<0.05)。结论与VCV联合PEEP机械通气模式比较,PCV联合PEEP机械通气模式应用于老年喉罩全麻腹腔镜手术中可提高患者的Vt和Cdyn,减小肺部压力,减轻肺损伤,在保持良好氧合功能的同时能减少呼吸系统并发症发生风险,临床应用时可优先考虑。

Objective To explore the application effect of pressure controlled ventilation(PCV)combined with positive end-expiratory pressure(PEEP)mechanical ventilation and volume controlled ventilation(VCV)combined with PEEP mechanical ventilation in elderly patients undergoing laparoscopic surgery with laryngeal mask general anesthesia.Methods From February 2020 to January 2021,300 elderly patients undergoing laparoscopic surgery with laryngeal mask general anesthesia in the operating room of our hospital were selected as the research objects.The patients were divided into control group and observation group according to the random number table method,with 150 cases in each group.The control group received VCV combined with PEEP mechanical ventilation mode,and the observation group received PCV combined with PEEP mechanical ventilation mode.The respiratory mechanics indexes,blood gas analysis indexes,lung injury indexes at 5 min after entering the operating room(T_(0)),5 min after undergoing endotracheal intubation VCV ventilation(T_(1)),5 min after establishing artificial pneumoperitoneum(T_(2)),35 min after establishing artificial pneumoperitoneum(T_(3))and after the end of artificial pneumoperitoneum(T_(4))and postoperative respiratory complications were compared between the two groups.Results At T_(1),T_(2),T_(3) and T_(4),the tidal volume(Vt)and dynamic lung compliance(Cdyn)in the observation group were higher than those in the control group,while the plateau pressure(Pplat)and peak airway pressure(Ppeak)were lower than those in the control group(P<0.05).At T_(1),T_(2),T_(3) and T_(4),there was no significant difference in the end-tidal carbon dioxide pressure(PETCO2)between the two groups(P>0.05).At T_(1),T_(2),T_(3) and T_(4),the arterial partial pressure of oxygen(PaO2)and oxygenation index(OI)in the observation group were higher than those in the control group,while the arterial carbon dioxide partial pressure(PaCO2)was lower than that in the control group(P<0.05).At T_(1) and T_(4),the respiratory index(RI)in the observation group was lower than that in the control group(P<0.05).At T_(1),T_(2),T_(3) and T_(4),the levels of interleukin-6(IL-6)and soluble receptor of advanced glycation end product(sRAGE)in the observation group were lower than those in the control group(P<0.05).The total incidence of postoperative respiratory complications in the observation group was 4.67%,which was lower than 12.67%in the control group(P<0.05).Conclusion Compared with VCV combined with PEEP mechanical ventilation mode,PCV combined with PEEP mechanical ventilation mode applied in elderly patients undergoing laparoscopic surgery with laryngeal mask general anesthesia can improve Vt and Cdyn,reduce pulmonary pressure,alleviate lung injury,maintain good oxygenation function and reduce the risk of respiratory complications,which can be given priority in clinical application.