不同机械通气模式对腹腔镜结直肠癌手术呼吸力学参数的影响

Effects of Different Mechanical Ventilation Modes on Respiratory Mechanics of Patients Nndergoing Laparoscopic Colorectal Cancer Surgery

目的探讨腹腔镜结直肠癌手术中,不同机械通气模式联合呼气末正压(PEEP)对患者呼吸力学参数的影响。方法选取行腹腔镜下结直肠癌根治术的患者90例,随机分为3组,每组30例。容量控制通气模式组(V组)、压力控制通气模式组(P组)、压力控制容量保证通气模式组(G组)。记录并比较术中不同时刻呼吸参数指标。结果3组患者在气腹后的气道平均压(Pmean)、气道峰压(Ppeak)、呼气末二氧化碳分压(P_(ETCO)_(2))均升高,而肺动态顺应性(Cydn)降低;与G组比较,V组的Pmean、Ppeak、P_(ETCO)_(2)升高,Cydn降低;P组的P_(ETCO)_(2)升高。结论PCV-VG及PCV机械通气模式与VCV机械通气模式相比,气道压力显著降低,肺动态顺应性更高。而由于气腹对机械通气的影响,P_(ETCO)_(2)均较气腹前增高,PCV-VG机械通气模式比PCV机械通气模式在呼吸机参数设置上调整更少。因此对于行腹腔镜下结直肠癌手术的患者来说,PCV-VG联合PEEP更安全,更有益。

Objective To investigate the effect of different mechanical ventilation modes and PEEP on patient respiratory mechanics in laparoscopic colorectal cancer surgery.Methods 90 patients with radical laparoscopic colorectal cancer were divided into three groups(n=30):volume-controlled ventilation mode group(Group V),pressure-controlled ventilation mode group(Group P),and pressure-controlled capacity-guaranteed ventilation mode group(Group G).The respiratory parameters at different times during operation were recorded and compared.Results In the three groups,Pmean,Ppeak and P_(ETCO)_(2)increased(P<0.05),Cydn decreased after the air abdom enestablished;compared with group G,Pmean,Ppeak and P_(ETCO)_(2)increased,Cydn decreased in group V,and P_(ETCO)_(2)increased in the P group.Conclusion The PCV-VG and PCV ventilation patterns showed increased lung compliance and lower airway pressure as compared to the VCV ventilation pattern.PCV-VG needs less adjustment when setting ventilator parameters than PCV.Therefore,PCV-VG combined with PEEP is safer and more beneficial for patients undergoing laparoscopic colorectal cancer surgery.