压力控制容量保证用于婴幼儿先天性心脏病术中肺保护性通气的效果  

Efficacy of PCV-VG mode for lung protective ventilation in infants with congenital heart disease undergoing cardiac operation

作　　者：陈小莉[1] 魏利娟[1] 郭仲辉[1] 马亚飞[1] CHEN Xiaoli;WEI Lijuan;GUO Zhonghui;MA Yafei(Department of Anesthesiology,the First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学临床医学院,河南科技大学第一附属医院,洛阳471003

出　　处：《实用医学杂志》2020年第4期470-474,共5页The Journal of Practical Medicine

基　　金：河南省医学科技攻关计划项目(编号:201602167);河南省科技计划项目(编号:172102310686)。

摘　　要：目的观察压力控制容量保证(pressure-controlled volume-guaranteed,PCV-VG)用于婴幼儿先心病心脏手术的肺保护性通气效果。方法80例1~5岁先心病房(室)间隔缺损患儿,体质量8.5~18 kg,ASAⅡ~Ⅲ级。采用随机数字表法将患儿分为两组,每组40例。P组采用PCV-VG模式通气,V组采用定容控制通气(volume controlled ventilation,VCV)模式通气,VT=8 m L/kg,I∶E为1∶1.5,PEEP 3 mmHg,氧流量为1.5 L/min,RR 18~25次/min,吸入氧浓度(FIO2%)0.6。根据血气分析结果及PETCO2(维持在35~45 mmHg)调整呼吸参数。记录气管插管后5 min(T0)、30 min(T1)、60 min(T2)、CPB结束后30 min(T3)、CPB结束后60 min(T4)呼吸力学指标并行动脉血气分析计算PA-aDO2、氧合指数(OI)、呼吸指数(RI);记录拔管时间、ICU驻留时间、住院时间及术后心肺并发症发生情况等。结果与V组比较,P组T1~4时刻PPeak、PPlat均降低,P组Cdyn在T2~4时点均升高;与V组比较,P组T2~4时刻OI升高,PA-aDO2、RI下降;与V组比较,P组拔管时间、ICU停留时间及术后住院时间明显缩短。结论PCV-VG用于婴幼儿先心病心脏手术可有效的降低气道压,改善肺顺应性,增加肺通气与氧合效率,可产生肺保护性通气效果,有助于改善患儿预后。Objective To investigate the effect of pressure-controlled volume-guaranteed(PCV-VG)mode for lung protective ventilation in infants with congenital heart disease undergoing cardiac operation.Methods Eighty patients,aged 1~5 yr,with weighing 8.5~18 kg,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for repair of atrial(ventricular)septal defect under general anesthesia,were randomly divided into 2 groups(n=40 each)using a random number table:PCV-VG group and volume controlled ventilation(VCV)group.The ventilator settings were adjusted,with a tidal volume 8 mL/kg and respiratory rate18~25 breaths/min and positive end-expiratory pressure 3 mmHg.The inspiratory/expiratory ratio was 1:1.5 and60%oxygen was inhaled at 1.5 L/min.The end-tidal pressure of carbon dioxide was maintained at 35~40 mmHg.Alveolar-arterial oxygen difference(PA-aO2),oxygenation index(OI),respiratory index(RI),The airway peak pressure(Ppeak),airway platform pressure(Plat),pulmonary dynamic compliance(Cdyn)were measured at 5,30,60 min after tracheal intubation(TO-2)and at 30,60 min after cardiopulmonary bypass(T3-4).The extubation time,ICU time and length of postoperative hospital stay"were recorded.Result PCV-VG resulted in significantly lower PA-aO2,RI,Ppeak,Plat compared with VC ventilation(P<0.05),and significantly higher OI,Cdyn versus VC ventilation(P<0.05)at T2-4.Compared with group V,the extubation time,ICU time and length of postoperative hospital stay were shortened in group P(P<0.05).Conclusion In general infants undergoing cardiac operation,PCV-VG mode can achieve lung protective ventilation,which is helpful in lowering airway pressure and improving oxygenation function.PCV-VG mode can promote the early recovery of infants undergoing cardiac operation.

关 键 词：婴幼儿 机械通气 呼吸力学 肺保护 心脏手术 

分 类 号：R614[医药卫生—麻醉学]