压力控制容量保证在Trendelenburg位机器人辅助腹腔镜手术中的应用价值  

Application value of PCV-VG ventilation in long-time robot-assisted laparoscopic surgery in Trendelenburg position

作　　者：邢瑞 蒿梦潇 杨森 茆烨 颜明 XING Rui;HAO Mengxiao;YANG Sen;MAO Ye;YAN Ming(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;不详)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221002 [2]徐州医科大学,江苏徐州221004

出　　处：《实用医学杂志》2023年第4期465-470,共6页The Journal of Practical Medicine

基　　金：江苏省教育厅高校省级重点实验室开放基金资助项目(编号:KJS08004)。

摘　　要：目的 探究在Trendelenburg位长时间机器人辅助腹腔镜手术中应用压力控制容量保证通气模式对患者呼吸力学和肺功能的影响。方法 选择择期行机器人辅助腹腔镜下腹部手术患者76例,随机分为压力控制容量保证通气组(P组)和容量控制通气组(V组)。记录诱导后即刻(T_(2)),气腹后20 min(T_(3))、1 h(T_(4))、2 h(T_(5))、3 h(T_(6)),放气腹后10 min(T_(7))的气道峰压、气道平台压、肺动态顺应性及气道阻力;记录诱导前(T_(1))、T_(2)-T_(7)、拔管后20 min(T_(8))的氧合指数及肺内分流率;记录术后肺部并发症发生率,并用超声评估T_(1)、T_(8)及术后第1、3天的肺不张情况。结果 呼吸力学:与T_(2)相比,两组气腹期间(T_(3)-T_(6))的气道峰压、平台压、气道阻力及肺动态顺应性变化差异均有统计学意义(P <0.05);与V组相比,P组T_(3)-T_(7)的气道峰压和平台压,T_(3)-T_(6)的气道阻力均显著降低(P <0.05),肺顺应性除T_(2)、T_(3)外均显著增高(P <0.05)。肺功能:与T_(1)相比,两组T_(2)-T_(7)氧合指数和肺内分流率变化差异有统计学意义(P <0.05);与V组相比,P组T_(4)-T_(6)的肺内分流率显著降低、T_(5)-T_(6)的氧合指数显著升高(P <0.05)。两组术后并发症发生率差异无统计学意义(P> 0.05);术后P组肺不张程度较V组显著降低(P <0.05)。结论 与容量控制通气相比,压力控制容量保证通气可降低气道峰压、平台压和气道阻力,提高肺顺应性,改善氧合和肺内分流,减少术后肺不张,应用于长时间Trendelenburg位机器人辅助腹腔镜手术具有一定优势。Objective To investigate the effects of applying pressure-controlled and volume-guaranteed ventilation mode during prolonged robotic-assisted laparoscopic surgery in the Trendelenburg position on patients′respiratory mechanics and pulmonary function.Methods Seventy-six patients undergoing elective robot-assisted laparoscopic lower abdominal surgery were selected and randomly divided into pressure-controlled volume-guaranteed ventilation group(group P)and volume-controlled ventilation group(group V).The peak airway pressure,airway plateau pressure,dynamic lung compliance and airway resistance were recorded immediately after induction(T_2),20 min(T_3),1 h(T_4),2 h(T_5)and 3 h(T_6)after pneumoperitoneum,and 10 min after extubation(T_7);the oxygenation index and intrapulmonary shunt rate were recorded before induction(T_1),T_2-T_7,and 20 min after extubation(T_8);the postoperative pulmonary complication rate,and pulmonary atelectasis was assessed by ultrasound at T_1,T_8,and on postoperative days 1 and 3.Results Respiratory mechanics:compared with T_2,the differences in peak airway pressure,plateau pressure,airway resistance and dynamic lung compliance during pneumoperitoneum(T_3-T_6)in both groups were statistically significant(P<0.05);compared with group V,peak airway pressure and plateau pressure in T_3-T_7and airway resistance in T_3-T_6in group P were significantly lower(P<0.05),and lung compliance was significantly higher except for T_2and T_3(P<0.05).Lung function:compared with T_1,there were significant differences in the changes of oxygenation index and intrapulmonary shunt rate from T_2to T_7in both groups(P<0.05);compared with group V,the intrapulmonary shunt rate from T_4to T_6and oxygenation index from T_5to T_6in group P were significantly lower(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P<0.05);the degree of postoperative pulmonary atelectasis was significantly lower in group P compared with group V(P<0.05).Conclusion Compared wi

关 键 词：压力控制容量保护 机器人辅助手术 长时间气腹 肺功能 

分 类 号：R614[医药卫生—麻醉学]