不同通气模式对腹腔镜结直肠癌手术患者全麻期间呼吸功能的影响  

Effects of different ventilation modes on respiratory function during general anesthesia in patients undergoing laparoscopic colorectal cancer surgery

作　　者：王珊 闵红星 王月新 WANG Shan, MIN Hongxlng , WANG Yuexin(1Department of Anesthesiology, Cangzhou People＇s Hospital, Cangzhou 061000; 2Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinehuan 750000, Chin)

机构地区：[1]沧州市人民医院麻醉科,河北沧州061000 [2]宁夏医科大学总医院麻醉科,宁夏银川750000

出　　处：《麻醉安全与质控》2018年第4期196-199,共4页Perioperative Safety and Quality Assurance

摘　　要：目的评价不同通气模式对腹腔镜结直肠癌手术患者全麻期间呼吸功能的影响。方法选取沧州市人民医院2017年8~12月择期行腹腔镜结直肠癌手术患者60例,年龄18~60岁,体质量指数(BMI)18~25 kg/m^2,ASA分级Ⅰ~Ⅲ级。将患者随机分为压力控制通气组(P组,n=30)和容量控制通气组(V组,n=30)。两组患者均在麻醉诱导后行气管插管,连接麻醉机行机械通气。P组调节吸入气体压力,使目标潮气量(V_T)达8 mL/kg;V组直接设置V_T为8 mL/kg;2组均通过调节呼吸频率(RR)维持呼气末二氧化碳分压(P_(ET)CO_2)30~40 mm Hg,其余麻醉方法相同。观察2组患者麻醉诱导前(T_0)、麻醉诱导气管插管后10 min(T_1)、气腹+头低脚高位后10 min(T_2)、气腹+头低脚高位后60 min(T_3)、气腹+头低脚高位后120 min(T_4)、气腹解除恢复仰卧位后20 min(T_5)的氧合功能[动脉血氧分压(PaO_2)、氧合指数(OI)、呼吸指数(RI)、肺泡动脉血氧分压差(A-a DO_2)]及呼吸力学参数[气道峰压(Ppeak)、气道平均压(Pmean)、动态肺顺应性(Cdyn)、动脉血二氧化碳分压(PaCO_2)]的变化。结果与V组比较,P组在T_2~T_5时间点Pa CO_2降低(P<0.05);在T_2~T_4时间点RI、A-aDO_2、Ppeak降低,PaO_2、OI、Pmean、Cdyn升高(P<0.05)。结论与容量控制通气(VCV)相比,压力控制通气(PCV)可更好的改善腹腔镜结直肠癌手术患者的通气效果,促进气体交换,降低气道阻力。Objective This study evaluates the effects of different ventilation modes on respiratory function during general anesthesia in patients undergoing laparoscopic colorectal cancer surgery.MethodsSixty patients aged between 18 and 60 years old with BMI 18-25 kg/m2 and ASA physical statusⅠ-Ⅲwere randomized to receive either pressure control ventilation（group P,n=30）or volume control ventilation（group V,n=30）during laparoscopic colorectal cancer surgery.Endotracheal intubation was performed after anesthesia induction and then all patients received mechanical ventilation.The tidal volume（VT）in both Group P and Group V was set at 8 m L/kg by adjusting the inspiratory pressure.Respiration rate（RR）was adjusted to maintain the end-tidal CO2（P（ET）CO2）at 30-40 mm Hg.Oxygenation parameters（Pa O2,OI,RI,A-a DO2）and respiratory mechanics（Ppeak,Pmean,Pa CO2,Cdyn）were measured before anesthesia induction（T0）,10 min after tracheal intubation（T1）,10 min（T2）,60 min（T3）and 120 min（T4）after pneumoperitoneum and Trendelenburg position,20 min after pneumoperitoneum removed and patient was returned to supine position（T5）.Results Compared with the group V,the Pa CO2 was decreased at T2-T5（P〈0.05）in group P;the RI,A-a DO2,Ppeak were also decreased at T2-T4.The Pa O2,OI,Pmean,Cdyn were increased in group P（P〈0.05）.Conclusion When compared with volume control ventilation,pressure control ventilation can improve ventilatory function,promote gas exchange,decrease airway resistance in patients undergoing laparoscopic colorectal cancer surgery.

关 键 词：压力控制通气 容量控制通气 呼吸功能 腹腔镜 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]