喉罩通气方式对妇科腹腔镜手术患者的影响

Effects of laryngeal mask airway ventilation mode on patients with gynecological laparoscopic surgery

目的比较妇科腹腔镜手术中使用喉罩通气道(laryngeal mask airway,LMA)条件下应用容量控制通气(volume controlled ventilation,VCV)和压力控制通气(pressure controlled ventilation,PCV)对呼吸力学、血流动力学、血气分析及气体交换的影响。方法选取2022年3月至2022年7月温州市人民医院收治的妇科腹腔镜手术患者60例作为研究对象,分为VCV组和PCV组,每组30例。两组均在LMA插入后5 min(T1)、15 min(T2)、气腹后15 min(T3)采集动脉血进行血气分析,监测记录呼吸力学参数。结果T1和T2时,VCV组气道峰压和平台压明显高于PCV组(P<0.05)。与VCV组相比,PCV组在T2和T3时动脉血氧分压(partial pressure of oxygen,PaO2)明显较高(P<0.05);PCV组的动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))在T1、T2时明显较低(P<0.05),T3时两组的PaCO_(2)无明显差异(P>0.05);PCV组中的呼气末二氧化碳分压(partial pressure of end-tidal carbon dioxide,PetCO_(2))浓度在T2、T3时明显较VCV组低(P<0.05)。结论VCV和PCV均适用于妇科腹腔镜手术,但PCV的气道压力低于VCV,选用PCV对预防肺的气道压力伤具有一定意义。

Objective To compare the effects of volume controlled ventilation(VCV)mode and pressure controlled ventilation(PVC)mode on respiratory mechanics,hemodynamics,blood gas analysis and gas exchange under the condition of laryngeal mask airway(LMA)in gynecological laparoscopic surgery.Methods A total of 60 gynecological laparoscopic patients admitted to Wenzhou People’s Hospital from March 2022 to July 2022 were selected and divided into VCV group(30 cases)and PCV group(30 cases).Arterial blood was collected for blood gas analysis at 5 mins after LMA insertion(T1),15 mins after LMA insertion(T2)and 15 mins after pneumoperitoneum insertion(T3),and respiratory mechanical parameters were monitored and recorded in both groups.Results At T1 and T2,the peak airway pressure and plateau pressure in VCV group were significantly higher than those in PCV group(P<0.05).Compared with VCV group,PaO2 in arterial blood in PCV group was significantly higher at T2 and T3(P<0.05).Compared with VCV group,PaCO2 in PCV group was obviously lower at T1 and T2(P<0.05),and there was no significant difference in PaCO2 between two groups at T3(P>0.05).Compared with VCV group,PetCO2 concentration in PCV group was significantly lower at T2 and T3(P<0.05).Conclusion Both VCV and PCV are suitable for gynecologic laparoscopy,however,the airway pressure of PCV is significantly lower than that of VCV,and using PCV would be helpful in preventing airway pressure injuries in the lung.