压力控制通气与容量控制通气在胸科手术单肺通气中的比较  

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery

作　　者：李晶[1] 徐向辉[1] 邹小华[1] 常业恬[1] 

机构地区：[1]中南大学湘雅二医院麻醉科,长沙市410011

出　　处：《实用医学杂志》2009年第11期1771-1773,共3页The Journal of Practical Medicine

摘　　要：目的:比较胸科手术麻醉中单肺通气(OLV)期间采用压力控制通气(PCV)与容量控制通气(VCV)对血流动力学、气道压力以及动脉血气的影响。方法:选择30例择期肺叶切除的成年患者,ASA分级Ⅰ～Ⅱ级,麻醉诱导后插入双腔管,先双肺通气,OLV开始后患者随机分为A、B两组。A组(n=15)OLV期间采用VCV模式通气,B组(n=15)OLV期间使用PCV模式通气。比较两组各时段的血流动力学、气道峰压(Ppeak)、气道平均压(Pmaw)、动脉血氧分压(PaO2)以及肺内分流率(Qs/Qt)。结果:两组间各时段的血流动力学指标差异无显著性(P>0.05)。A组和B组OLV期间的Ppeak分别为(28±5)cmH2O和(23±3)cmH2O,差异有统计学意义(P<0.05)。A组的Qs/Qt比B组高[(41.3±9.5)%vs(35.3±8.4)%,P<0.05]。PaO2分别为(27.6±14.5)kPa和(31.1±13.3)kPa,差异无统计学意义(P<0.05)。结论:胸科手术OLV期间采用PCV模式在降低气道压,减少肺内分流,增加动脉血氧分压等方面优于VCV模式。Objective To compare the impacts of pressure-controlled ventilation （PCV） with volume-controlled ventilation （VCV） on hemodynamic state, airway pressures, and arterial oxygenation during one-lung ventilation （OLV） for thoracic surgery. Methods 30 ASA Ⅰ - Ⅱadult patients undergoing lobectomy with two-lung ventilation followed by one-long ventilation after anesthetic induction were randomized to receive VCV （group A, n = 15）, or PCV （group B, n = 15）. Hemodynamics, peak airway pressure （Ppeak）, mean airway pressure （Pmaw）, PaO2, and pulmonary shunt （Qs/ Qt） were determined at different time points in both groups. Results Hemodynamic indices did not differ significantly between the two groups（P 〉 0.05）. Ppeak was （28 ± 5）cmH2O in group A and （23 ±3）cmH2O in group B（P 〈 0.05）; Qs/Qt was higher in group A than in group B [（41.3 ± 9.5）% vs （35.3 ± 8.4）%,P 〈 0.05] ; PaO2 was （27.6 ± 14.5）kPa and （31.1 ± 13.3） kPa, respectively（P 〈 0.05）. Conclusion During OLV for thoracic surgery, PCV is superior to VCV in lowering airway pressure, reducing pulmonary shunt, and increasing PaO2.

关 键 词：肺通气 容量控制 压力控制 呼吸力学 血气分析 

分 类 号：R655[医药卫生—外科学] R614[医药卫生—临床医学]