压力调节容量控制通气在胸腔镜肺大疱手术中的使用  

Pressure-regulated volume-controlled ventilation during videothoracoscopic bleb excision

作　　者：邬晓雷[1] 潘志浩[1] 郭建荣[1] 

机构地区：[1]宁波市医疗中心李惠利医院麻醉科,315041

出　　处：《中国医师进修杂志》2010年第9期16-17,共2页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较压力调节容量控制通气（PRVCV）和容量控制通气（vcv）在胸腔镜肺大疱手术中使用的差别。方法连续20例胸腔镜肺大疱切除术患者进入研究。诱导后置入支气管阻塞导管，定位成功后进行单肺通气。患者首先分别选用VCV或PRVCV中的一种模式通气20min，然后改用另一种模式通气20min。两种模式中潮气量均设定6ml／kg，呼吸频率为15次／min，吸呼比为1：2。比较两种通气模式下气道峰压、血流动力学（心率、血压）、血气分析指标。结果VCV时气道峰压显著高于PRVCV时[分别为（18．2±4．3）cmH2O（1cmH2O=0．098kPa）和（12．7±3．6）PmH2O，P〈0．01]。两种通气模式下动脉血氧分压、动脉血二氧化碳分压、潮气量、心率和血压比较差异均无统计学意义（P〉0．05）。结论与VCV相比，PRVCV运用于单肺通气可以在不影响氧合的情况下，提供较低的气道峰压。Objective To explore the difference between pressure-regulated volume controlled ventilation （PRVCV） and volume controlled ventilation （VCV） during videothoracoscopic bleb excision. Methods Consecutive 20 patients scheduled to undergo videothoracoscopic bleb excision were enrolled into the study. After induction, endotracheal blocker was advanced into endotraeheal tube to establish one-lung ventilation, each patient was randomly assigned to receive successively PRVCV and VCV for 20 minutes. Ventilatory variables were kept constantly（tide volume 6 ml/kg,respiratory rate 15 breaths/min and I ： E ratio 1 ： 2）. Heart rate, blood pressure, peak airway pressure and blood gas parameters were compared. Results Peak airway pressure was significantly lower with PRVCV than that with VCV [ （12.7 ± 3.6 ） cm H2O （1 cm H2O = 0.098 kPa） vs （18.2 ± 4.3） em H2O,P 〈 0.01 ]. However,there was no significant difference in arterial oxygen tension, arterial partial pressure of carbon dioxide, heart rate and blood pressure between PRVCV and VCV. Conclusion During one-lung ventilation in videothoracoscopic bleb excision,PRVCV offers lower peak inspiratory airway pressures while maintaining equal oxygenation compared with VCV.

关 键 词：肺通气 胸腔镜 肺大疱 

分 类 号：R614[医药卫生—麻醉学]