PCV-VG模式对Trendelenburg体位腹腔镜结肠手术老年患者肺通气的影响  

Effect of pressure-controlled ventilation-volume guaranteed on lung ventilation in elderly patients undergoing laparoscopic Trendelenburg postural colon surgery

作　　者：诸光峰 王和节 蒋毅 顾叶春 李奕铮 ZHU Guang-feng;WANG He-jie;JIANG Yi;GU Ye-chun;LI Yi-zheng(Department of Anesthesiology,Wenzhou Integrated Traditional Chinese and Western Medical Hospital,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州市中西医结合医院麻醉科,浙江温州325000

出　　处：《中华全科医学》2022年第7期1139-1142,1165,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2021KY1081);温州市医药卫生科研项目(2018A04)。

摘　　要：目的观察压力控制容量保证通气(PCV-VG)对Trendelenburg体位腹腔镜结肠手术老年患者肺通气的影响。方法选择2020年5月—2021年4月温州市中西医结合医院结肠手术患者60例,以随机数字表法分为容量控制通气组(V组)30例和PCV-VG组(P组)30例。记录各时点(T1~T6)的平均动脉压(MAP)、心率(HR)、动态肺顺应性(Cdyn)、气道峰压(Ppeak)、气道平台压(Pplat)和呼气末二氧化碳分压(PetCO_(2))。记录术中pH、PaO_(2)及PaCO_(2),计算氧合指数(OI),观察术后5 d内肺部并发症情况。结果2组患者组间各时点MAP及HR差异无统计学意义,2组T1~T6的HR均比T0增加(均P<0.05)。与T1比较,2组患者T4和T5时pH降低。随体位变换时间增加,2组患者PaO_(2)下降,PaCO_(2)上升,OI下降(均P<0.05)。在T5时,组间比较,V组PaO_(2)及OI低于P组。在T3~T6,V组Ppeak及Pplat升高,Cdyn下降;T4~T5,P组Cdyn下降。在T5时,V组Ppeak值[(25.4±2.1)cm H_(2)O vs.(16.3±2.1)cm H_(2)O,1 cm H_(2)O=0.098 kPa]、Pplat值[(9.0±0.5)cm H_(2)O vs.(7.0±0.6)cm H_(2)O]高于P组,Cdyn值[(33.2±6.3)mL/cm H_(2)O vs.(40.3±5.2)mL/cm H_(2)O]低于P组。P组高碳酸血症发生率[3.3%(1/30)]比V组[23.3%(7/30)]低,差异无统计学意义(χ^(2)=3.606,P=0.057)。结论PCV-VG适用于腹腔镜下Trendelenburg体位结肠手术老年患者,可降低气道压,提高氧合指数,减少术后并发症。Objective To observe the effect of pressure-controlled ventilation volume guaranteed(PCV-VG)on lung ventilation in elderly patients undergoing Trendelenburg position laparoscopic colon surgery.Methods Total 60 patients with colon surgery in Wenzhou Integrated Traditional Chinese and Western Medical Hospital from May 2020 to April 2021 were randomly divided into volume control ventilation group(V group,n=30)and PCV-VG group(P group,n=30).The mean arterial pressure(MAP),heart rate(HR),dynamic compliance(Cdyn),inspiratory peak pressure(Ppeak),plateau airway pressure(Pplat)and the partial pressure of end-tidal carbon dioxide(PetCO_(2))were recorded at different time point(T1-T6).The pH,PaO_(2) and PaCO_(2) were determined by blood gas analysis and oxygenation index(OI)and pulmonary complications were calculated within 5 days after operation.Results There was no statistical significance in MAP and HR between V and P group.The HR at T1-T6 in both groups was higher than that in T0(P<0.05).Patients in both groups with T4 and T5 had lower PH compared to T1.The PaO_(2) and OI decreased and PaCO_(2) increased in both group with the increase in body position change time(P<0.05).In T5,compared with P group,the PaO_(2) and OI values were decreased while PaCO_(2) values increased in V group.At T3-T6,Ppeak and Pplat were increased and Cdyn decreased in V group compared with p group.The Cdyn at T4-T5 in P group was decreased compared with V group.At the time point of T5:Ppeak value was(25.4±2.1)cm H_(2)O(1 cm H_(2)O=0.098 kPa)in V group vs.(16.3±2.1)cm H_(2)O in P group;the Pplat value was(9.0±0.5)cm H_(2)O in V group vs.(7.0±0.6)cm H_(2)O in P group,and the Cdyn value was(33.2±6.3)mL/cm H_(2)O in V group vs.(40.3±5.2)mL/cm H_(2)O in P group.The percentage of hypercapnia in group P(3.3%,1/30)was lower than that in group V(23.3%,7/30),but the difference was not statistically significant(χ^(2)=3.606,P=0.057).Conclusion PCV-VG can effectively reduce airway pressure of lung ventilation,improve oxygenation index and reduce post

关 键 词：通气模式 压力控制容量保证通气 体位 TRENDELENBURG 结肠手术 老年人 肺通气 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]