PCV-VG模式联合右美托咪定对腹腔镜袖状胃切除术患者术中呼吸力学和血气指标的影响

Effect of PCV-VG Mode Combined with Dexmedetomidine on Intraoperative Respiratory Mechanics and Blood Gas Indicators in Patients Undergoing Laparoscopic Sleeve Gastrectomy

目的探析在腹腔镜袖状胃切除术中,使用PCV-VG通气模式联合右美托咪定镇静对肥胖患者术中呼吸力学和血气指标的影响。方法选取2022年7月至2023年12月在昆明市第一人民医院行腹腔镜袖状胃切除术的患者132例,随机分为VCV机械通气模式组(V组),PCV-VG机械通气模式组(P组),VCV模式联合静脉泵注右美托咪定组(D组),PCV-VG模式联合静脉泵注右美托咪定组(PD组),每组33例。对比4组患者麻醉诱导前20 min(T0),气管插管后10 min(T1),建立CO_(2)气腹后40 min(T2),放气腹后10 min(T3)的氧分压(PaO_(2)),二氧化碳分压(PaCO_(2)),气道峰压(P_(peak)),气道平均压(P_(mean)),肺动态顺应性(C_(dyn))。结果(1)血气指标:在T2、T3时点,P、D、PD组的PaO_(2)均高于V组,差异有统计学意义(P<0.01),其中PD组高于其他3组,差异有统计学意义(P<0.01);PaCO_(2)均低于V组,差异有统计学意义(P<0.01),其中PD组低于其他3组,差异有统计学意义(P<0.01)。(2)呼吸力学指标:在T1时点4组的P_(peak)无明显统计学差异,P﹥0.05。PD组的P_(peak)在T2、T3时点均低于V、P、D组,差异有统计学意义(P<0.01);C_(dyn)均高于其他3组,差异有统计学意义(P<0.01);P_(mean)在T1、T2、T3时点PD组均低于P组,差异有统计学意义(P<0.01)。结论PCV-VG通气模式联合静脉泵注右美托咪定在腹腔镜袖状胃切除术中可改善肥胖患者术中的氧和功能,降低气道峰压,提高肺顺应性,减少机械性肺损伤。

Objective To explore the effects of PCV-VG ventilation mode combined with dexmedetomidine sedation on intraoperative respiratory mechanics and blood gas indicators in obese patients undergoing laparoscopic sleeve gastrectomy.Methods 132 patients who underwent laparoscopic sleeve gastrectomy at Kunming First People's Hospital from July 2022 to December 2023 were randomly divided into VCV mode group(Group V),PCV-VG mode group(Group P),VCV mode combined with dexmedetomidine pump group(Group D),and PCV-VG mode combined with dexmedetomidine pump group(Group PD),with 33 patients in each group.Then we compared the oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),peak airway pressure(P_(peak)),mean airway pressure(P_(mean)),and lung dynamic compliance(C_(dyn))of four groups of patients 20 minutes before anesthesia induction(T0),10 minutes after tracheal intubation(T1),40 minutes after CO_(2) pneumoperitoneum establishment(T2),and 10 minutes after deflation(T3).Results(1)Blood gas indicators:At time points T2 and T3,the PaO_(2) levels in the P,D,and PD groups were higher than those in the V group,with P<0.01,indicating a statistically significant difference,Among them,the PD group was higher than the other three groups,with P<0.01,indicating a statistically significant difference;And PaCO_(2) was lower than that of Group V,P<0.01,with statistically significant differences,Among them,the PD group was lower than the other three groups,P<0.01,with statistically significant differences.(2)Respiratory mechanics indicators:At T1,there was no significant statistical difference in P_(peak) among the four groups,with P>0.05.The P_(peak) of the PD group was lower than that of the V,P,and D groups at time points T2 and T3,with P<0.01,and the difference was statistically significant;And C_(dyn) was higher than the other three groups,with P<0.01,and the difference was statistically significant;At T1,T2,and T3,P_(mean) was lower in the PD group than in the P group,with P<0.01,and the difference was statistically significant.Conclusion PCV-VG ventilation mode combined with intravenous infusion of dexmedetomidine can improve oxygen and function during laparoscopic sleeve gastrectomy in obese patients,reduce airway peak pressure,improve lung compliance,and reduce mechanical lung injury.