三种不同机械通气模式在经支气管镜超声引导针吸活检术中的应用比较  

Application of three different mechanical ventilation modes in endobronchial ultrasound-guided transbronchial needle aspiration

作　　者：吕袁凯 曹卓[1] 王发兴 王洪源[1] 韩新[2] 代虹 Lyu Yuankai;Cao Zhuo;Wang Faxing;Wang Hongyuan;Han Xin;Dai Hong(Department of Respiratory Medicine,Lishui City People's Hospital,Lishui 323000,Zhejiang Province,China;Department of Anesthesiology,Lishui City People's Hospital,Lishui 323000,Zhejiang Province,China)

机构地区：[1]丽水市人民医院呼吸内科,浙江省323000 [2]丽水市人民医院麻醉科,浙江省323000

出　　处：《中国基层医药》2021年第5期641-645,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医学会临床科研资金项目(2018ZYC-A163)。

摘　　要：目的比较容量控制通气(VCV)、压力控制通气(PCV)、压力控制容量保证通气(PCV-VG)模式对经支气管镜超声引导针吸活检术(EBUS-TBNA)中患者呼吸力学及呼吸功能指标的影响。方法选择丽水市人民医院2019年2-12月收治的在全身麻醉下行EBUS-TBNA的患者75例,采用随机数字表法分为VCV组(V组)、PCV组(P组)和PCV-VG组(G组),各25例。经排除/剔除后,V组25例,P组24例,G组24例。在EBUS-TBNA术中分别采用VCV、PCV、PCV-VG通气模式对患者进行机械通气。分别记录和计算超声支气管镜(EBUS)进入气管前(T0)、操作30 min时(T1)、操作60 min时(T2)、操作结束即刻(T3)患者气道峰压(Ppeak)及肺动态顺应性(Cdyn)、动脉血二氧化碳分压(PaCO2)、氧合指数(OI)。结果 P组与V组比较,P组在T2、T3时刻Ppeak分别为(22.5±5.2)cmH2O、(16.2±2.8)cmH2O,低于V组的(25.8±3.5)cmH2O、(18.2±3.2)cmH2O(q=3.672、3.454,P=0.031、0.045);T1-T3时刻Cdyn分别为(26.4±5.0)mL/cmH2O、(24.1±4.5)mL/cmH2O、(32.5±4.2) mL/cmH2O,高于V组的(23.0±2.7)mL/cmH2O、(19.9±2.1)mL/cmH2O、(28.5±3.7)mL/cmH2O(q=3.732、4.795、4.118,P=0.027、0.004、0.013)。G组与V组比较,G组在T2、T3时刻Ppeak分别为(21.7±4.3)cmH2O、(15.6±2.6)cmH2O,低于V组的(25.8±3.5)cmH2O、(18.2±3.2)cmH2O(q=4.493、4.332,P=0.006、0.009);T1-T3时刻Cdyn分别为(26.6±5.6)mL/cmH2O、(24.3±5.6)mL/cmH2O、(33.2±6.3)mL/cmH2O,高于V组的(23.0±2.7)mL/cmH2O、(19.9±2.1)mL/cmH2O、(28.5±3.7)mL/cmH2O(q=3.852、4.936、4.791,P=0.022、0.002、0.003);T2、T3时刻PaCO2分别为(41.1±3.8)mmHg、(38.4±3.4)mmHg,低于V组的(45.7±3.4)mmHg、(41.0±3.0)mmHg(q=5.969、3.682,P=0.000、0.030);T2时刻OI为(358.0±32.8)mmHg,高于V组的(326.6±29.7)mmHg(q=4.782,P=0.003);P组和G组的各项指标各时刻比较,差异均无统计学意义(均P>0.05)。结论在操作时间>60 min的EBUS-TBNA术中,采用PCV-VG模式进行机械通气,不仅能降低气道压,提高肺顺应性,而且能预防呼吸性酸中毒,改善氧合�Objective To compare the effects of volume-controlled ventilation(VCV),pressure-controlled ventilation(PCV)and pressure controlled ventilation-volume guarantee(PCV-VG)on respiratory mechanics and respiratory function index in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA).Methods Seventy-five patients who underwent EBUS-TBNA under general anesthesia during February to December in 2019 in Lishui City People's Hospital,China were included in this study.They were randomly assigned to undergo VCV(Group V),PCV(Group P)or PCV-VG(Group G),with 25 patients in each group during EBUS-TBNA.After exclusion because of different reasons,25,24 and 24 patients from the Groups V,P and G respectively were included in the final analysis.Peak airway pressure(Ppeak),pulmonary dynamic compliance(Cdyn),the partial pressure of carbon dioxide in arterial blood(PaCO2),and oxygenation index(OI)at baseline(T0),at the time of EBUS-TBNA for 30(T1)and 60 min(T2)and immediately after EBUS-TBNA(T3).Results At T2 and T3,Ppeak in the Group P was(22.5±5.2)cmH2O and(16.2±2.8)cmH2O respectively,which was significantly lower than that in the Group V[(25.8±3.5)cmH2O,(18.2±3.2)cmH2O,q=3.672,3.454,P=0.031,0.045).At T1,T2 and T3,Cdyn in the Group P was(26.4±5.0)mL/cmH2O,(24.1±4.5)mL/cmH2O and(32.5±4.2)mL/cmH2O,respectively,which was significantly higher than that in the Group V[(23.0±2.7)mL/cmH2O,(19.9±2.1)mL/cmH2O,(28.5±3.7)mL/cmH2O,q=3.732,4.795,4.118,P=0.027,0.004,0.013).At T2 and T3,Ppeak in the Group G was(21.7±4.3)cmH2O,(15.6±2.6)cmH2O,respectively,which was significantly lower than that in the Group V[(25.8±3.5)cmH2O,(18.2±3.2)cmH2O,q=4.493,4.332,P=0.006,0.009].At T1,T2,and T3,Cydn in the Group G was(26.6±5.6)mL/cmH2O,(24.3±5.6)mL/cmH2O,(33.2±6.3)mL/cmH2O,which was higher than that in the Group V[(23.0±2.7)mL/cmH2O,(19.9±2.1)mL/cmH2O,(28.5±3.7)mL/cmH2O,q=3.852,4.936,4.791,P=0.022,0.002,0.003].At T2 and T3,PaCO2 in the Group G was(41.1±3.8)mmHg,(38.4±3.4)mmHg,respectively,which w

关 键 词：活组织检查 针吸 支气管镜检查 气道峰压 肺顺应性 容量控制通气 

分 类 号：R459.7[医药卫生—急诊医学]