压力和容量控制通气在老年单肺麻醉肺保护通气策略中的比较  

Comparison of pressure controlled with volume controlled ventilation in lung protective strategy during aged patient's one-lung anesthesia

作　　者：李风茹[1] 丁洁[2] 高景[1] 耿恩江[1] 申六女[1] 

机构地区：[1]河北省胸科医院,石家庄050041 [2]江苏省常州市第一人民医院

出　　处：《山东医药》2009年第40期11-13,共3页Shandong Medical Journal

基　　金：河北省科技厅科技攻关计划项目(072761203)

摘　　要：目的比较老年开胸手术单肺通气中压力控制通气(PCV)和容量控制通气(VCV)模式对呼吸力学和动脉血气的影响。方法46例术前肺功能不正常行开胸手术的患者,年龄均>60岁,双肺通气(TLV)期间均采用VCV模式(TLV-VCV),单肺通气(OLV)后先采用传统方法通气(OLV-VCV1),25 min后改为单肺保护通气(OLV-VCV2),25 min后再改为压力控制通气(OLV-PCV)。监测气道峰压(Ppeak)、气道平台压(Pplat)、气道阻力(Raw)、动态胸肺顺应性(Cdyn)、分钟通气量(MV)等。结果与TLV-VCV比较,OLV-VCV1模式时Ppeak、Pplat、Raw升高(P<0.01)、Cdyn降低(P<0.01)。与OLV-VCV1比较,OLV-VCV2及OLV-PCV时Ppeak、Pplat、Raw较低,Cdyn较好(P均<0.05)。OLV时动脉血PaO2较TLV时下降(P<0.01),OLV-PCV及OLV-VCV2时PaO2及PaCO2较OLV-VCV1升高(P<0.05)。结论PCV模式控制气道压更有利于减少气道损伤,更适用于肺功能不全行开胸手术的老年患者。Objective To investigate the significance and effect of pressure controlled ventilation （PCV） as well as volume controlled ventilation （VCV） on respiratory mechanics and arterial blood gas analysis in aged patients underwent thoracic surgery. Methods Forty-six aged patients over 60 years with abnormal pulmonary function underwent thoracic surgery were mechanically ventilated with VCV during two-lung ventilation （TLV） and one-lung ventilation （OLV）. All patients were mechanically ventilated with traditional VCV （ OLV-VCV1 ） for 25 min at first, then with protective VCV （OLV-VCV2） for 25 min and followed by PCV for 25 min. The respiratory mechanics index was measured by side stream spirometry （SSS） including peak airway pressure （Ppeak）, plateau pressure （Pplat）, airway resistance （Raw）, lung compliance （Cdyn） and inspiratory and expiratory minute ventilation （Mvi, Mve）. Arterial blood gases were obtained at the end of each ventilation mode. Results Ppeak, Pplat and Raw were significantly higher during OLV-VCV1 than during TLV-VCV （ P 〈 0.01 ）, whereas Cdyn was significantly lower （ P 〈 0.01 ）. Ppeak, Pplat and Raw were lower during OLVVCV2 and OLV-PCV than during OLV-VCV1 （P 〈 0.05 ）, Cdyn was higher （P 〈 0.05 ）. Arterial oxygen pressure （ PaO2 ） significantly decreased during OLV than during TLV （P 〈 0.01 ）. PaO2 and PaCO2 significantly increased during OLV-PCV and OLV-VCV2 than during OLV-VCV1 （P 〈 0.05 ）. Conclusion For the aged patients with abnormal pulmonary function, PCV can lead to lower airway pressure and should be a preferable controlled ventilation mode.

关 键 词：压力控制通气 容量控制通气 单肺保护通气 老年人 

分 类 号：R614.2[医药卫生—麻醉学]