腹腔镜术中PRVC呼吸模式的应用研究  

Application of PRVC in laparoscopic surgery

作　　者：段霞光[1] 黄再青[2] 郝春光[2] 支小军[2] 齐小冰[2] 任玲[2] 栾胜辉[2] 梁成光[1] 

机构地区：[1]内蒙古大学生命科学院,呼和浩特市010070 [2]内蒙古包钢医院包头,014010

出　　处：《实用医学杂志》2017年第3期375-378,共4页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:81560251)

摘　　要：目的:通过在气腹过程中对PC、VC和PRVC 3种呼吸模式进行呼吸力学的监测并、对比、研究,来探讨PRVC呼吸模式临床使用的意义及价值。方法:腹腔镜胆囊切除术患者90例,随机分为压力控制、容量控制、压力调节容量控制通气3组,每组30例。分别在患者气腹前、气腹后5、10、15、20 min等5个时项段记录:食管压力、气道平均压、气道压峰值、动脉二氧化碳分压、呼气末CO_2浓度或分压、潮气量、平均动脉压、心率。结果:VC模式的PES在气腹后明显高于PC和PRVC模式。PC和VC模式气腹后10 min开始PaCO_2和ETCO_2明显升高(P<0.05);PC不仅会使PaCO_2和ETCO_2升高,而且气腹后TV明显低于其他两组(P<0.05)。PC和VC组气腹后通过使PaCO_2和ETCO_2上升,使MAP、HR显著升高(P<0.05)。气腹后PRVC组MAP、HR显著低于PC、VC组(P<0.05)。结论:PRVC模式可有效降低气腹引起的PAWM、PAP、PES升高,避免PaCO_2和ETCO_2在手术期的异常升高,保证围手术期患者的生命体征平稳。Objective To monitor and compare the breathing mechanics on PC, VC and PRVC during pneumoperitoneum, and to discuss the significance of the clinic use of PRVC. Method Ninety laparoscopic cholecystectomy patients were equally divided into 3 groups （PC, VC, PRVC）. Levels of PES, PAWM, PAP, PaCO2, ETCO2, TV MAP and HR were detected before pneumoperitoneum, and at 5, 10, 15 and 20 minutes post- pneumoperitoneum. Results Pneumoperitoneum made three respiratory patterns with different levels of PAWM, PAP, and PES. PES post-pneumoperitoneum in the VC model was obviously higher than that in the PC and PRVC group. At 10 min post-pneumoperitoneum, levels of PaCO2 and ETCO2 increased obviously in the PC and VC group（P〈 0.05）. Levels of PaCO2 and ETCO2 were increased in the PC group, but TV level post-pneumoperitoneum was significantly lower than that in the other two groups （P 〈 0.05）. Level of PaCO2 and ETCO2 were increased in the PC and VC group post-pneumoperitoneum, along with increases of MAP and HR （P 〈 0.05）. Levels of MAP and HR in the PRVC group post-pneumoperitoneum were significantly lower than those in the PC and VC group （P 〈 0.05）. Conclusion PRVC mode can effectively reduce the increases of pneumoperitoneum-induced PAWM, PAP, PES, without the unusual increase of PaCO2 and ETCO2 during surgeries, contributing to the stability of vital signs of perioperative patients.

关 键 词：压力调节容量控制通气 腹腔镜 食道压 二氧化碳分压 呼末二氧化碳 

分 类 号：R657.4[医药卫生—外科学]