压力控制通气用于小儿喉罩通气全麻腹腔镜阑尾切除术的临床观察  

The application of pressure-controlled ventilation in laparoscopic appendectomy under general anesthesia of laryngeal mask airway in children

作　　者：许峰 董峰 孙大鹏 高田[1] XU Feng;DONG Feng;SUN Da-peng;GAO Tian(Department of Anesthesiology,Bengbu First People′s Hospital,Bengbu Anhui233000,China)

机构地区：[1]安徽省蚌埠市第一人民医院麻醉科

出　　处：《蚌埠医学院学报》2019年第10期1356-1357,1361,共3页Journal of Bengbu Medical College

摘　　要：目的:观察小儿腹腔镜阑尾切除术喉罩通气全麻时压力控制通气(PCV)的临床效果。方法:选择年龄为2~10岁行腹腔镜阑尾切除术的患儿56例,随机分为PCV组(P组)和容量控制通气组(V组),观察2组各时点的气道峰压(Ppeak)、平台压(Pplat)、平均动脉压(MAP)、心率(HR)及动脉血气、喉罩漏气率、不良反应的发生情况和术后呼吸系统并发症的情况。结果:气腹后V组喉罩漏气率及胃胀气率与P组差异无统计学意义(P>0.05);术后24h内,2组呼吸系统检查均未出现相关并发症;2组气腹开始前各项指标差异均无统计学意义(P>0.05),气腹后2组Ppeak、Pplat、PaCO2、PaO2及HR均升高,MAP降低(P<0.05~P<0.01);T2和T3时点V组Ppeak、Pplat均高于P组(P<0.01),2组其他各项指标差异无统计学意义(P>0.05)。结论:PCV能在相对低的气道压力下提供有效的肺通气,有利于气体交换,减少CO2气腹对呼吸功能的影响,尤其在小儿喉罩通气全麻时较容量控制通气更有优势。Objective:To observe the clinical effects of pressure controlled ventilation(PCV)in laparoscopic appendectomy under general anesthesia of laryngeal mask airway in children.Methods:Fifty-six children aged 2-10 years old treated with laparoscopic appendectomy were randomly divided into the PCV group(group P)and volume-controlled ventilation group(group V).The airway peak pressure(Ppeak),plat pressure(Pplat),mean arterial pressure(MAP),heart rate(HR)and arterial blood gas at different time-points,and leakage rate of laryngeal mask,incidence rate of adverse reactions and postoperative respriatory complications in two groups were observed.Results:There was no statistical significance in the leakage rate of laryngeal mask or rate of flatulence between two groups after pneumoperitoneum(P>0.05).The related complications of respiratory system in two groups were not found within 24 h after operation.The difference of the related complications between two groups was not statistically significant before pneumoperitoneum(P>0.05).After pneumoperitoneum,the Ppeak,Pplat,PaCO2,PaO2 and HR increased significantly,and the MAP decreased significantly in two groups(P<0.05 to P<0.01).The Ppeak and Pplat in group V at T2 and T3 were significantly higher than those in group P(P<0.01),and there was no statistical significance in other indicators between two groups(P>0.05).Conclusions:PCV can effectively provide the pulmonary ventilation under the relatively low airway pressure,is good for gas exchange,can reduce the effect of CO2 pneumoperitoneum on respiratory function,has more advantages over the volume-controlled ventilation,especially in general anesthesia of laryngeal mask airway for children.

关 键 词：腹腔镜阑尾切除术 压力控制通气 喉罩 麻醉 小儿 

分 类 号：R656.8[医药卫生—外科学]