两种通气模式对小儿腹腔镜下Proseal喉罩通气功能的影响  

Effects of two ventilation modes on ventilatory function of Proseal laryngeal mask in children under laparoscopy

作　　者：涂远艳[1] 汪志勇[1] 方进龙[1] 

机构地区：[1]广东省东莞市妇幼保健院麻醉科,广东东莞523000

出　　处：《中国医药导报》2017年第4期54-57,共4页China Medical Herald

基　　金：广东省东莞市医疗卫生科技一般项目(2016105101067)

摘　　要：目的比较小儿腹腔镜下Proseal喉罩通气时压力控制通气(PCV)和容量控制通气(VCV)这两种通气模式对气道压力和喉罩漏气的影响。方法选择东莞市妇幼保健院2016年6月~8月在全麻下行腹腔镜疝囊高位结扎术的小儿40例,年龄3~12岁,体重12~50 kg,ASAⅠ~Ⅱ级。静脉快速诱导后置入proseal喉罩。随机分为A组(PCV通气)、B组(VCV通气)两种通气方式。通气期间保持相同的呼气末二氧化碳分压(PETCO_2)。观测两组患儿气道峰压、气道平台压、漏气率、呼气潮气量以及心率(HR)、平均动脉血压(MAP)、呼气末二氧化碳分压(PETCO_2)、动脉血二氧化碳分压(Pa CO_2)和动脉血氧分压(Pa O_2)。结果除呼气潮气量A组高于B组,比较无统计学意义,气道峰压、气道平台压和漏气率指标,A组明显低于B组(P<0.05)。A组有1例(5%)气道峰压>20 cm H_2O,而B组有8例(40%)气道峰压>20 cm H_2O,差异有统计学意义(P<0.05);两组患者的HR、MAP、PETCO_2和血氧饱和度(SPO_2)比较均无统计学意义(P>0.05)。Pa CO_2和Pa O_2这两个指标,气腹后10 min、气腹放气后5 min,A组与B组比较显示差异均有统计学意义(P<0.05)。不良反应发生率,A组和B组分别为25%、35%,A组与B组比较存在差异统计学意义(P<0.05)。结论 PCV通气模式对小儿腹腔镜下proseal喉罩通气功能影响小,并发症发生率低,能在较低的气道压力下提供有效的肺通气。Objective To compare the effects of pressure-controlled ventilation （PCV） and volume control ventilation （VCV） on airway pressure and airway leakage in laryngoscopicproseal laryngeal mask ventilation. Methods 40 children underwent laparoscopic high ligation of hernia sac under general anesthesia of Maternal and Child Health Care Hospital of Dongguan from June to August in 2016,aged 3 to 12 years old,weighing 12-50kg,ASA I -II class.Intravenous rapid induction of proseal laryngeal laryngeal mask placement.Were randomly divided into two groups： group A （PCV ventilation） and group B （VCV ventilation）.The same end-tidal carbon dioxide partial pressure （PETCO2） was maintained during aeration.（HR）,mean arterial blood pressure （MAP）,end-tidal carbon dioxide partial pressure （PETCO2）,arterial blood carbon dioxide （CO2）,heart rate （HR）,airway pressure Pressure （PaCO2） and arterial oxygen pressure （PaO2）. Results The level of respiratory tidal volume in group A was higher than that in group B,while the peak airway pressure,airway pressure and air leak rate in group A were significantly lower than those in group B （P 〈 0.05）.In group A,there were 1 case （5%） peak airway pressure〉20 cmH20,and 8 cases （40%） in group B had peak airway pressure〉20 cmH20,There were no significant differences in HR,MAP,PETCO： and SPO2 between the two groups （P 〉 0.05）.After 10 rain of pneumoperitoneum and 5 min after pneumoperitoneum,there was significant difference between group A and group B （P 〈 0.05） in PaCO2 and PaO2.The incidence of adverse reactions was 25% and 35% in group A and B,respectively.There was significant difference between group A and group B （P 〈 0.05）. Conclusion PCV ventilation mode has little effect on the proseal laryngeal mask airway ventilation in children,the incidence .of complications is low,and can provide effective pulmonary ventilation at low airway pressure.

关 键 词：PROSEAL喉罩 正压通气 压力控制通气 容量控制通气 

分 类 号：R614[医药卫生—麻醉学]