压力控制-容量保证通气联合右美托咪定对腹腔镜手术患儿的肺保护作用  

Lung-protective effect of pressure-controlled volume-guaranteed ventilation combined with dexmedetomidine in pediatric patients undergoing laparoscopic surgery

作　　者：朱春花 于健[1] 王本清[1] 聂宇[1] 王雷[1] Zhu Chunhua;Yu Jian;Wang Benqing;Nie Yu;Wang Lei(Department of Anesthesiology,Cangzhou Center Hospital,Cangzhou 061001,China)

机构地区：[1]沧州市中心医院麻醉科,沧州061001

出　　处：《中华麻醉学杂志》2023年第3期322-325,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价压力控制-容量保证通气(PC-VG)模式联合右美托咪定对腹腔镜手术患儿的肺保护作用。方法择期行腹腔镜肾盂成型术患儿48例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄2~6岁,体质量8~21 kg。采用随机数字表法分为3组(n=16):容量控制通气(VCV)组(V组)、PC-VG组(P组)、PC-VG联合右美托咪定组(PD组)。PD组于麻醉诱导前静脉输注右美托咪定负荷剂量0.5μg/kg,输注时间15 min,随后以0.2~0.5μg·kg^(-1)·h^(-1)的速率持续静脉输注至手术结束。V组采用VCV模式,P组与PD组采用PC-VG模式,机械通气期间3组VT 6~8 ml/kg,RR 15~25次/min,吸呼比为1︰2,氧流量2 L/min,吸入氧浓度60%,维持PETCO_(2)35~40 mmHg。于气腹前5 min(T_(0))、气腹10 min(T_(1))、60 min(T_(2))、120 min(T_(3))、气腹压力释放后10 min(T_(4)),记录气道峰压(Ppeak)、平均气道压(Pmean)、肺顺应性(CL)和气道阻力(Raw),记录肺泡-动脉血氧分压差(PA-aO_(2))、氧合指数(OI)、呼吸指数(RI)。记录术后7 d内肺部并发症的发生情况。结果与V组比较,P组与PD组T_(1~4)时Ppeak和Raw降低,CL升高,T_(3,4)时PA-aO_(2)和RI降低,OI升高(P<0.05);与P组比较,PD组各时间点上述呼吸力学指标差异无统计学意义(P>0.05),T_(3,4)时PA-aO_(2)和RI降低,OI升高(P<0.05)。3组术后肺部并发症发生率比较差异无统计学意义(P>0.05)。结论PC-VG模式联合右美托咪定对腹腔镜手术患儿具有一定肺保护作用。Objective To evaluate the protective effect of pressure-controlled volume-guaranteed ventilation(PC-VG)combined with dexmedetomidine on the lung of pediatric patients undergoing laparoscopic surgery.Methods Forty-eight pediatric patients of either sex,aged 2-6 yr,weighing 8-21 kg,scheduled for elective laparoscopic pyeloplasty,were divided into 3 groups(n=16 each)using a random number table method:volume-controlled ventilation(VCV)group(V group),PC-VG group(P group),and PC-VG combined with dexmedetomidine group(PD group).In PD group,dexmedetomidine was intravenously infused for 15 min at a loading dose of 0.5μg/kg starting from the time point before anesthesia induction followed by a continuous infusion of 0.2-0.5μg·kg^(-1)·h^(-1) until the end of operation.VCV mode was used in group V,and PC-VG mode was used in P and PD groups,ventilator settings were adjusted to the mode with a tidal volume 6-8 ml/kg,respiratory rate 15-25 breaths/min,inspiratory/expiratory ratio 1∶2,oxygen flow rate 2 L/min,fraction of inspired oxygen 60%,and PETCO_(2) was maintained at 35-40 mmHg during mechanical ventilation in three groups.At 5 min before pneumoperitoneum(T_(0)),10,60 and 120 min of pneumoperitoneum(T_(1-3))and 10 min after release of pneumoperitoneum pressure(T_(4)),peak airway pressure(Ppeak),mean airway pressure(Pmean),compliance of lung(CL)and airway resistance(Raw)were recorded,alveolar-arterial oxygen partial pressure difference(PA-aO_(2)),oxygenation index(OI),and respiratory index(RI)were recorded.The occurrence of pulmonary complications was recorded within 7 days after operation.Results Compared with V group,the Ppeak and Raw were significantly decreased and CL was increased at T_(1-4),and PA-aO_(2) and RI were decreased and OI was increased at T_(3,4) in P group and PD group(P<0.05).Compared with P group,no significant change was found in the parameters of respiratory mechanics mentioned above at each time point(P>0.05),and PA-aO_(2) and RI were decreased and OI was increased at T_(3,4) in PD group(P<0.05).

关 键 词：呼吸 人工 右美托咪啶 儿童 腹腔镜检查 

分 类 号：R726.1[医药卫生—儿科]