婴儿Ambu喉罩通气下压力与容量控制通气的呼吸动力学比较  

Comparison of respiratory dynamics between pressure controlled ventilation and volume controlled ventilation in infants undergoing general anesthesia with laryngeal mask airway-Ambu

作　　者：刘珺珺[1] 顾志清[1] 金泉英[1] 陈莲华[2] 

机构地区：[1]上海交通大学附属儿童医院麻醉科,上海200040 [2]上海交通大学附属第一人民医院麻醉科

出　　处：《上海医学》2015年第6期484-488,共5页Shanghai Medical Journal

摘　　要：目的采用连续气道监测手段，观察婴儿使用Ambu喉罩通气时，压力控制通气（PCV）与容量控制通气（VCV）的呼吸动力学指标差异。方法选择6～12月龄择期行尿道下裂手术的患儿40例，按随机数字表法分人PCV组和VCV组，每组20例，患儿在静脉麻醉诱导后，置人Ambu喉罩，分别行PCV和VcV。在通气期间维持患儿呼气末二氧化碳分压（PetCO2）为30～40mmHg（1mmHg-0．133kPa）。记录喉罩置人时（T1）和置人后10min（T2）、20min（T3）、30min（T4）时的呼吸动力学和血流动力学指标。观察喉罩相关不良反应的发生情况。结果VCV组在T4时间点的呼气阻力（RE）显著高于同组T，时间点（P〈0．05）；在T3、T4时间点的气道峰压（PIP）值显著高于PCV组同时间点（P值均〈0．05），而呼气峰流速（PEF）值显著低于PCV组同时间点（P〈0．05）。两组在T1时间点的肺顺应性（Compl）值显著高于同组其他时间点（P〈0．05），呼吸功（wOB）显著高于同组T3、T4时间点（P值均〈0．05）。VCV组的漏气分数、吸入潮气量（VTin）、呼出潮气量（VTex）、PIP、吸气平台压（Pplat）、呼气末正压（PEEP）、平均气道压（Pmean）、PetCO2、PEF和PCV组的漏气分数、VTinVTexPIP、Pplat、PEEP、Pmean、PcCO2、PEF、RE虽随时间变化略有波动，但组内差异均无统计学意义（P值均〉0．05）。两组间各时间点的漏气分数、VTin、VTex、Pplat、PEEP、Pmena、pctCO2、Comp1、RE和wOB的差异均无统计学意义（P值均〉0．05）。结论PCV和VCV均能安全地应用于使用Ambu喉罩通气的6～12月龄患儿。但随着手术时间的延长，行VCV患儿的PIP呈升高趋势，可能增加安全隐患，因此PCV可能更安全。Objective To compare the differences of respiratory dynamics between pressure controlled ventilation （PCV） and volume controlled ventilation （VCV） in infants undergoing general anesthesia with laryngeal mask airway-Ambu （LMA-Ambu） by continuous airway monitoring. Methods Forty infants, aged from 6 to 12 months, scheduled for hypospadias repair were randomly divided into PCV group and VCV group （n = 20）. After intravenous anesthesia induction, LMA-Ambu was inserted. Then PCV or VCV was performed in infants of the two groups, respectively. The partial pressure of carbon dioxide in endexpiratory gas （Pet 002 ） maintained between 30 mmHg （1 mmHg-- 0. 133 kPa） and 40 mmHg. Parameters of respiratory mechanics, such as tidal volume （VTin/VTex）, peak inspiratory pressure （PIP）, plateau airway pressure （Pplat）, mean airway pressure （Pmean）, positive end expiratory pressure （PEEP）, peak expiratory flow （PEF）, and Pet 002, were recorded 0 （T1）, 10 min（T2 ）, 20 min（T3 ）, and 30 min （T4） after intubation. Meanwhile, the hemodynamic changes and complications were recorded. Results Expiratory resistance （RE） at T4 was significantly higher than that at T~ in the VCV group （ P 〈0. 05）. PIP in the VCV group was significantly increased while PEF was significantly decreased as compared with those in the PCV group at T3 and T4 （both P〈0.05）. In both groups, pulmonary compliance （Compl） at T1 was significantly higher than those at any other time points, and work of breathing （WOB） at T1 was significantly higher than those at T3 and T4 （all P〈0.05）. There were no significant differences in fraction of leakage, VTin/VTex, Pplat, PEEP, Pmean,, petCO2, Compl, RE or WOB between groups at any time point （all P〉0.05）. Neither were fraction of leakage, VTin/VTex, PIP, Pplat, PEEP, petCO2, PEF in the VCV group or fraction of leakage, VTin/VTex, PIP, pplat, PEEP, pmean, petCO2, PEF, RE in the PCV group （all P〉0.05）. Conclusion Both PCV and

关 键 词：婴儿 喉罩 容量控制通气 压力控制通气 

分 类 号：R726.1[医药卫生—儿科]