不同通气模式对DeBakey Ⅰ型主动脉夹层手术体外循环后气道压力和动脉血气的影响  

Effect of different ventilation modes on the airway pressure and arterial blood gas after cardiopulmonary bypass of DeBakey type I aortic dissection surgery

作　　者：周莉莉[1] 骆璇[1] 

机构地区：[1]南京大学医学院附属南京鼓楼医院麻醉科,江苏省南京市210008

出　　处：《中国心血管病研究》2017年第12期1116-1119,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨容量控制通气（VCV）和压力控制通气（PCV）对DeBakey Ⅰ型主动脉夹层手术体外循环（CPB）后气道压力和动脉血气的影响.方法 60例全麻下行DeBakey Ⅰ型主动脉夹层手术的患者随机分为2组（A组和B组,每组30例）.所有患者麻醉诱导气管插管后均采用传统的VCV模式.CPB后A组继续采用VCV模式,30 min后转换为PCV模式;B组则先采用PCV模式,30 min后转换为VCV模式.分别在每种通气模式结束后行动脉血气分析,同时记录气道压力、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）及动脉血氧饱和度（SaO2）.结果 与CPB前VCV模式相比,CPB后VCV和PCV模式下PaO2下降[（179.4±100.4）mm Hg比（235.7±121.2）mm Hg],平均气道压（Pmean）[（10.4±2.2）cm H2O比（8.7±1.8）cm H2O]和气道峰压（Ppeak）[（20.2±3.6）cm H2O比（18.3±3.0）cm H2O]升高（P＜0.05）;与CPB后VCV模式相比,CPB后PCV模式下Pmean[（8.7±1.8）cm H2O]和Ppeak[（18.3±3.0）cm H20]降低（P＜0.05）,而Pa02[（235.7±121.2）mmHg]升高（P＜0.05）;与CPB前VCV模式相比,CPB后VCV和PCV模式下PaCO2、SaO2均无统计学差异（P＞0.05）.结论 DeBakey Ⅰ型主动脉夹层手术CPB后,与VCV模式相比,PCV模式下能提高氧合作用,且气道压力低,可防止加重气道损伤.Objective To investigate the effect of volume controlled ventilation （VCV） and pressure controlled ventilation （PCV） on the airway pressure and arterial blood gas after cardiopulmonary bypass of DeBakey type Ⅰ aortic dissection surgery.Methods 60 cases of patients undergoing DeBakey type Ⅰ aortic dissection surgery were randomly divided into 2 groups （Group A and group B,30 cases in each group）.All of the patients after anesthesia induction of endotracheal intubation adopt traditional VCV.After cardiopulmonary bypass,group A continued to undergoing VCV for 30 minutes followed by PCV for a similar duration,and group B underwent PCV initially for 30 minutes followed by VCV for a similar duration.Arterial blood glass and airway pressure were obtained at the end of each ventilation mode.Artery partial pressure of carbon dioxid（PaCO2）,artery partial pressure of oxygenation （PaO2） and artery oxygen saturation （SaO2） were recorded.Results Compared with VCV before CPB,PaO2 was descended[（179.4±100.4）mm Hg vs （235.7±121.2）mm Hg],mean airway pressure（Pmean）[（10.4± 2.2）cm H2O vs （8.7±1.8）cm H2O] and peak airway pressure （Ppeak）[（20.2±3.6）cm H2O vs （18.3±3.0）cm H2O] were ascended by VCV and PCV after CPB （P〈0.05）;compared with VCV after CPB,Pmean （8.7±1.8）cm H2O and Ppeak（18.3±3.0）cm H2O were descended by PCV after CPB（P〈0.05）,and PaO2 （235.7±121.2）mm Hg was ascended （P〈0.05）;compared with VCV before CPB,PaCO2,SaO2 showed no significant differences by VCV and PCV after CPB（P〉0.05）.Conclusion Compared with VCV after cardiopulmonary bypass of DeBakey type Ⅰ aortic dissection surgery,PCV is able to improve oxygenation and decrease lower airway pressure,so it can prevent aggravate airway injury.

关 键 词：体外循环 容量控制通气 压力控制通气 动脉血气 气道压力 

分 类 号：R654.2[医药卫生—外科学]