PCV-VG和VCV模式用于老年患者腹腔镜腹部手术的术中氧合功能及创伤程度评估  

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

作　　者：普隽[1] 徐文韵[1] 袁红斌[1] PU Jun XU Wen-yun YUAN Hong-bin(Anesthesiology Department, Shanghai Changzheng Hospital, Shanghai, 20000)

机构地区：[1]上海市长征医院麻醉科,上海200003

出　　处：《海南医学院学报》2017年第3期369-372,376,共5页Journal of Hainan Medical University

基　　金：全军科技青年培育项目(13QN097)~~

摘　　要：目的:研究了PCV-VG和VCV模式用于老年患者腹腔镜腹部手术的术中氧合功能及创伤程度。方法:选择60例接受腹腔镜腹部手术的老年患者进行研究,随机分为两组,A组按照VCV序贯PCV-VG模式进行通气,B组按照PCV-VG序贯VCV模式进行通气,气腹开始前(T0)、气腹开始后第一种通气模式开始后1h(T_1)、切换通气模式通气后1h(T_2),气腹结束后(T_3)分别测定呼吸功能参数、动脉血气参数以及血清损伤指标。结果:T_1时间点处,A组患者的P_(peak)、P_(mean)、P_(plant)均显著高于B组,PaO_2显著低于B组,SpO_2、PaCO_2与B组无显著性差异;T_2和T_3时间点处,A组的P_(peak)、P_(mean)、Pp la n t均显著低于B组,PaO_2显著低于B组,SpO_2、PaCO_2与B组无显著性差异。T_1时间点处,A组的血清sRAGE、KL-6、TNF-α、MDA含量显著高于B组;T_3时间点处,A组的血清sRAGE、KL-6、TNF-α、MDA含量显著低于B组。结论:PCV-VG模式用于老年患者腹腔镜腹部手术能够降低气道压力、改善肺顺应性以及肺泡氧化、减轻肺损伤以及全身创伤。Objective：To study the intraoperative oxygenation function and trauma degree of PCV-VG and VCV mode for elderly patients with laparoscopic abdominal surgery.Methods：A total of 60 elderly patients with laparoscopic abdominal surgery were selected for study and randomly divided into two groups,group A received ventilation in accordance with sequen-tial VCV-PCV-VG mode,group B received ventilation in accordance with the sequential PCV-VG-VCV mode,and the respira-tory function parameters and arterial blood gas parameters and serum damage indexes were determined before the start of pneu-moperitoneum （T0 ）,1h after the start of the first ventilation mode after the start of pneumoperitoneum （T1 ）,1h after the switch of ventilation mode （T2 ）and after the end of pneumoperitoneum （T3 ）.Results：At T1 ,Pp e a k ,Pm e a n and Pp l a n t of group A were significantly higher than those of group B,PaO 2 was significantly lower than that of group B,and SpO 2 and＆nbsp;PaCO 2 were not significantly different from those of group B;at T2 and T3 ,Pp e a k ,Pm e a n and Pp l a n t of group A were signifi-cantly lower than those of group B,PaO 2 were significantly lower than those of group B,and SpO 2 and PaCO 2 were not signifi-cantly different from those of group B.At T1 ,serum sRAGE,KL-6,TNF-αand MDA content of group A were significantly higher than those of group B;at T3 ,serum sRAGE,KL-6,TNF-αand MDA content of group A were significantly lower than those of group B.Conclusion：PCV-VG mode for elderly patients with laparoscopic abdominal surgery can reduce airway pres-sure,improve lung compliance and alveolar oxidation,and reduce lung injury and systemic trauma.

关 键 词：腹腔镜 压力控制容量保证通气模式 容量控制通气模式 氧化功能 肺损伤 

分 类 号：R473.6[医药卫生—护理学]