Assessment of intraoperative oxygenation function and trauma degree of PCV-VG and VCV mode for elderly patients with laparoscopic abdominal surgery

Objective:To study the intraoperative oxygenation function and trauma degree of pressure-controlled ventilation-volume guaranteed (PCV-VG) and volume-controlled ventilation (VCV) mode for elderly patients with laparoscopic abdominal surgery. Methods:60 elderly patients with laparoscopic abdominal surgery were selected for study and randomly divided into two groups (n=30), group A received ventilation in accordance with sequential VCV-PCV-VG mode, group B received ventilation in accordance with the sequential PCV-VG-VCV mode, and the respiratory function parameters and arterial blood gas parameters and serum damage indexes were determined before the start of pneumoperitoneum (T0), 1 h after the start of the first ventilation mode after the start of pneumoperitoneum (T1), 1 h after the switch of ventilation mode (T2) and after the end of pneumoperitoneum (T3). Results:At T1, Ppeak, mean airway pressure (Pmean) and plateau airway pressure (Pplant) of group A were significantly higher than those of group B (P<0.05), partial pressure of oxygen (PaO2) was significantly lower than that of group B (P<0.05), and pulse oxygen saturation (SpO2) and partial pressure of carbon dioxide (PaCO2) were not significantly different from those of group B;at T2 and T3, Ppeak, Pmean and Pplant of group A were significantly lower than those of group B (P<0.05), PaO2 were significantly lower than those of group B (P<0.05), and SpO2 and PaCO2 were not significantly different from those of group B. At T1, serum soluble receptor for advanced glycation end-product (sRAGE), KL-6 (krebs. von den Iungen-6), tumor necrosis factor-α(TNF-α) and malondialdehyde (MDA) content of group A were significantly higher than those of group B (P<0.05);at T3, serum sRAGE, KL-6, TNF-αand MDA content of group A were significantly lower than those of group B (P<0.05). Conclusions:PCV-VG mode for elderly patients with laparoscopic abdominal surgery can reduce airway pressure, improve lung compliance and alveolar oxidation, and reduce lung injury and systemic trauma.

Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

BACKGROUND At present,understanding of the most effective ventilation methods for treating chronic obstructive pulmonary disease(COPD)patients experiencing acute worsening symptoms and respiratory failure remains relatively limited.This report analyzed the efficiency and side effects of various ventilation techniques used for individuals experiencing an acute COPD exacerbation.AIM To determine whether pressure-controlled ventilation(PCV)can lower peak airway pressures(PAPs)and reduce the incidence of barotrauma compared to volume-controlled ventilation(VCV),without compromising clinical outcomes and oxygenation parameters.METHODS We have evaluated 600 patients who were hospitalized due to a severe COPD exacerbation,with 400 receiving mechanical ventilation for the respiratory failure.The participants were divided into two different groups,who were administered either VCV or PCV,along with appropriate management.We thereafter observed patients'attributes,clinical factors,and laboratory,radiographic,and arterial blood gas evaluations at the start and during their stay in the intensive care unit(ICU).We have also employed appropriate statistical methods for the data analysis.RESULTS Both the VCV and PCV groups experienced significant enhancements in the respiratory rate,tidal volume,and arterial blood gas values during their time in the ICU.However,no significant distinctions were detected between the groups in terms of oxygenation indices(partial pressures of oxygen/raction of inspired oxygen ratio)and partial pressures of carbon dioxide improvements.There was no considerable disparity observed between the VCV and PCV groups in the hospital mortality(32%vs 28%,P=0.53),the number of days of ICU stay[median interquartile range(IQR):9(6-14)d vs 8(5-13)d,P=0.41],or the duration of the mechanical ventilation[median(IQR):6(4-10)d vs 5(3-9)d,P=0.47].The PCV group displayed lower PAPs compared to the VCV group(P<0.05)from the beginning of mechanical ventilation until extubation or ICU departure.The occurrence of barotrauma was considerably lower in the PCV group in comparison to the VCV group(6%vs 16%,P=0.03).CONCLUSION Both VCV and PCV were found to be effective in treating patients with acute COPD exacerbation.However,PCV was associated with lower PAPs and a significant decrease in barotrauma,thus indicating that it might be a safer ventilation method for this group of patients.However,further large-scale study is necessary to confirm these findings and to identify the best ventilation approach for patients experiencing an acute COPD exacerbation.

PCV-VG和VCV模式对腹腔镜手术患者肺顺应性的影响

目的:探析压力控制容量保证(PCV-VG)模式与容量控制(VCV)模式对腹腔镜手术患者的应用价值。方法:将90例腹腔镜手术患者以掷硬币法分为A组(n=45)和B组(n=45),A组行VCV,B组行PCV-VG,比较2组血流动力学、动态肺顺应性、临床指标和并发症发生情况。结果:2组MAP在T2、T3、T4时点时均低于T1、T5时点(P<0.05);2组T3动态肺顺应性低于T2、T4,B组各时点均高于A组(P<0.05);2组各时间点的心率、拔管时间及并发症发生率比较差异均无统计学意义;B组术后住院时间短于A组(P<0.05)。结论:PCV-VG和VCV对腹腔镜手术患者血流动力学的影响一致,PCV-VG更有助于改善肺顺应性,促进术后恢复。

Effect of Rectus Plication during Abdominoplasty on the Mechanical Power and Airway Pressures: Comparison of Two Ventilatory Strategies

Background: Abdominoplasty is a commonly requested procedure for aesthetic improvement of the affected soft tissue layers of skin, fat, and muscle through the slightest incision feasible. The degree of plicature generates an increase in intraabdominal pressure that causes an increase in intrathoracic pressure. Pressure, volume, flow, and respiratory rate are components of a unique physical variable, the mechanical power (MP), and is an integrated variable linked to most factors related to postoperative pulmonary complications. Purpose: To assess the effect of rectus plication (RP) during abdominoplasty on lung pressures and the contribution to increasing the MP. Method: A open-label study was conducted at TJ Plast Advanced Center for Plastic Surgery in Tijuana, México, from September 2021 to May 2022. The study included forty-six female patients subjected to abdominoplasty or liposuction with abdominoplasty. After the induction of general anesthesia and neuromuscular blockade, they were allocated into two groups: Group 1 pressure control ventilation-volume guaranteed (PCV-VG) and Group 2 volume control ventilation (VCV). Respiratory pressures and MP were assessed before and after RP. Results: During VCV, patients had a greater increase in peak pressure (PIP) (P 0.000). Plateau pressure (Pplat) increased 1.78 ± 0.35 cmH2O in group 2 after RP (P = 0.001). MP had a greater increase in group 2 after RP (P 0.01). Conclusion: This prospective study showed that RP is related to an increase in PIP and Pplat and an increase in the MP better controlled with PCV-VG ventilation.

压力控制容量保证通气模式在腹腔镜肝细胞癌切除术中的应用

目的探讨压力控制容量保证通气(PCV-VG)模式在腹腔镜肝细胞癌(肝癌)切除术中的应用价值。方法本前瞻性研究对象为2021年1月至2021年12月解放军联勤保障部队第九〇九医院收治的75例行腹腔镜肝癌切除术患者。其中男46例,女29例;年龄33~69岁,中位年龄50岁。患者均签署知情同意书,符合医学伦理学规定。采用随机数字表法将75例患者分为容量控制通气(VCV)组、压力控制通气(PCV)组、PCV-VG组,每组25例。比较3组切肝开始前(T_(1))、切肝开始后10 min(T_(2))、切肝结束后10 min(T3)的平均动脉压(MAP)、中心静脉压(CVP)、心率、气道平均压力(P_(mean))、气道峰值压力(P_(peak))、动态肺顺应性(Cdyn),以及术后并发症发生率等指标。多组间比较采用单因素方差分析,两两比较采用LSD-t检验。率的比较采用χ2检验或Fisher确切概率法。结果VCV组、PCV组、PCV-VG组T_(2)的平均CVP分别为(3.5±0.6)、(3.0±0.6)、(2.6±0.5)cmH2O(1 cmH2O=0.098 kPa),PCV-VG组明显低于VCV组和PCV组(LSD-t=-18.452,-8.945;P<0.05)。3组T_(2)时P_(mean)和P_(peak)分别为(10.7±1.9)、(9.5±1.7)、(8.4±1.7)cmH2O和(23.6±1.5)、(20.65±2.2)、(18.5±2.3)cmH2O,PCV-VG组明显低于VCV组和PCV组(LSD-t=-21.245,-13.180和-27.521,-11.088;P<0.05)。3组T_(2)时Cdyn分别为(25±7)、(26±5)、(29±6)ml/cmH2O,PCV-VG组明显高于VCV组和PCV组(LSD-t=28.646,13.038;P<0.05)。3组手术时间、术中出血量、肝门阻断时间、切肝用时分别为(196±37)、(190±46)、(170±40)min,(164±27)、(152±34)、(137±39)ml,(20±5)、(17±5)、(16±4)min,(40±13)、(37±15)、(31±10)min,PCV-VG组明显低于VCV组和PCV组(LSD-t=-21.452,-37.192,-13.452,-17.457和-15.614,-18.514,-6.087,-11.551;P<0.05)。3组术后并发症发生率比较差异无统计学意义(P>0.05)。结论腹腔镜肝癌切除术中采用PCV-VG通气模式可降低气道压和改善肺顺应性,将术中CVP控制在较低水平可减少术中出血量和手术时间,且不增加术后并发症发生率。

单肺通气时两种通气模式对PetCO_2与PaCO_2相关性的影响

目的：探讨胸科开胸手术单肺通气定容通气模式下和定压通气模式下PetC02（呼气末二氧化碳分压）与PaCO2（动脉二氧化碳分压）的相关性。方法：选择40例择期左侧开胸手术单肺通气成年患者，ASAI～II级，随机分为A组（n=20）采用VCV（容量控制通气）模式通气、B组（n=20）采用PCV（压力控制通气）模式通气。比较两组各时段的PaCO2和PetCO2的差异及相关性。结果：经统计学分析，除第一时间点，两组同一时间点的PetC02比较及PaCO2比较差异均有统计学意义（P〈O．05），A组PetC02四个时间点比较及PaCO2四个时间点比较差异均有有统计学意义（P〈0．001），B组除PetCO2第三与第四个时间点比较差异无统计学意义外，余PetCO2各时间点相比较及PaCO2各时间点相比较差异均有统计学意义（P〈0．05）。单肺通气定压通气模式下PetCO2与PaCO2在各个时间点的相关系数均大于定容通气模式时。无论是定容还是定压通气模式，单肺通气时间越长，其PetCO2与PaCOz的相关系数也越小。结论：1．同双肺通气相比，单肺通气时定压通气模式下PaCO2及PetCO2的改变小于定容通气模式时。2．单肺通气时，定压通气模式下PetCO2与PaCO2的相关性好于定容通气模式时。3．在这两种通气模式下PetCO2与PaCO2的相关性与单肺通气的时间成反比。