不同通气模式对腹腔镜结直肠癌手术患者呼吸力学、血流动力学和生化代谢的影响  

Effects of different ventilation modes on respiratory mechanics,hemodynamics and biochemical metabolism in patients undergoing laparoscopic colorectal cancer surgery

作　　者：李娜[1] 包娜日素 王丽斯 李敏 张生茂 Li Na;Baona Ris;Wang Lisi;Li Min;Zhang Shengmao(Department of Pain,Huhhot First Hospital,Huhhot 010017,China;Department of Anesthesiology,Inner Mongolia People′s Hospital,Huhhot 010017,China)

机构地区：[1]呼和浩特市第一医院疼痛科,呼和浩特010017 [2]内蒙古自治区人民医院麻醉科,呼和浩特010017

出　　处：《中国医师进修杂志》2023年第5期449-454,共6页Chinese Journal of Postgraduates of Medicine

基　　金：内蒙古自然科学基金(2021MS08109);呼和浩特市科技计划项目(2021-社-7)。

摘　　要：目的比较压力控制通气(PCV)和容量控制通气(VCV)对腹腔镜结直肠癌手术患者呼吸力学、血流动力学、生化代谢的影响。方法回顾分析内蒙古自治区人民医院2019年8月至2020年6月78例行腹腔镜结直肠癌手术患者的临床资料。其中,采用PCV 39例(PCV组),VCV 39例(VCV组)。记录两组麻醉诱导后10 min(T_(1))、气腹+头低脚高后10 min(T_(2))、气腹+头低脚高后60 min(T_(3))、气腹+头低脚高后120 min(T_(4))的呼吸力学、血流动力学和生化代谢指标,呼吸力学指标包括平均气道压(P_(mean))、气道峰压(P_(peak))、呼气末二氧化碳分压(P_(ET)CO_(2))、动态肺顺应性(C_(Ldyn)),血流动力学指标包括平均动脉压(MAP)和心率,生化代谢指标包括碱过剩、血钠、血钾、酸碱度和血糖。结果PCV组T_(1)~T_(4) P_(mean)、P_(peak)和P_(ET)CO_(2)明显低于VCV组[P_(mean):(7.12±1.37)cmH_(2)O(1 cmH_(2)O=0.098 kPa)比(8.54±1.84)cmH_(2)O、(9.80±2.26)cmH_(2)O比(11.63±2.87)cmH_(2)O、(9.51±2.17)cmH_(2)O比(11.72±2.90)cmH_(2)O、(7.04±1.34)cmH_(2)O比(8.65±1.88)cmH_(2)O,P_(peak):(13.41±2.68)cmH_(2)O比(15.06±3.05)cmH_(2)O、(20.92±3.11)cmH_(2)O比(23.45±4.02)cmH_(2)O、(21.14±3.50)cmH_(2)O比(23.69±4.26)cmH_(2)O、(15.03±2.74)cmH_(2)O比(16.45±3.21)cmH_(2)O,P_(ET)CO_(2):(30.59±1.57)mmHg(1 mmHg=0.133 kPa)比(32.04±2.11)mmHg、(35.02±4.15)mmHg比(39.88±4.76)mmHg、(35.90±4.22)mmHg比(40.11±4.87)mmHg、(34.33±4.17)mmHg比(37.65±2.69)mmHg],C_(Ldyn)明显高于VCV组[(40.68±3.98)ml/cmH_(2)O比(35.47±2.56)ml/cmH_(2)O、(30.25±3.21)ml/cmH_(2)O比(22.40±2.75)ml/cmH_(2)O、(29.78±3.06)ml/cmH_(2)O比(22.60±2.81)ml/cmH_(2)O、(40.32±4.25)ml/cmH_(2)O比(33.61±2.81)ml/cmH_(2)O],差异有统计学意义(P<0.01或<0.05)。PCV组T_(1)~T_(4) MAP和心率明显低于VCV组,差异有统计学意义(P<0.01或<0.05)。PCV组T_(1)~T_(4)碱过剩、血钠、血钾和酸碱度明显高于VCV组,血糖明显低于VCV组,差异有统计学意义(P<0.01或<0.05)。结论与VCV相比Objective To compare the effects of pressure controlled ventilation(PCV)and volume controlled ventilation(VCV)on respiratory mechanics,hemodynamics and biochemical metabolism in patients undergoing laparoscopic colorectal cancer surgery.Methods The clinical data of 78 patients underwent laparoscopic colorectal cancer surgery from August 2019 to June 2020 in Inner Mongolia People′s Hospital were retrospectively analyzed.Among them,39 patients were treated with PCV(PCV group),and 39 were treated with VCV(VCV group).The respiratory mechanics,hemodynamics and biochemical metabolism indexes 10 min after anesthesia induction(T_(1)),10 min after pneumoperitoneum+low head and foot height(T_(2)),60 min after pneumoperitoneum+low head and foot height(T_(3))and 120 min after pneumoperitoneum+low head and foot height(T_(4))were recorded.The respiratory mechanical indexes included mean airway pressure(P_(mean)),airway peak pressure(P_(peak)),pressure of end tidal carbon dioxide(P_(ET)CO_(2))and dynamic lung compliance(C_(Ldyn));hemodynamic indexes included mean arterial pressure(MAP)and heart rate;and biochemical metabolic indexes included base excess,serum natrium,serum potassium,negative logarithm of the hydrogen ion concentration(pH)and blood glucose.Results The P_(mean),P_(peak) and P_(ET)CO_(2) T_(1) to T_(4) in PCV group were significantly lower than those in VCV group,P_(mean):(7.12±1.37)cmH_(2)O(1 cmH_(2)O=0.098 kPa)vs.(8.54±1.84)cmH_(2)O,(9.80±2.26)cmH_(2)O vs.(11.63±2.87)cmH_(2)O,(9.51±2.17)cmH_(2)O vs.(11.72±2.90)cmH_(2)O,(7.04±1.34)cmH_(2)O vs.(8.65±1.88)cmH_(2)O;P_(peak):(13.41±2.68)cmH_(2)O vs.(15.06±3.05)cmH_(2)O,(20.92±3.11)cmH_(2)O vs.(23.45±4.02)cmH_(2)O,(21.14±3.50)cmH_(2)O vs.(23.69±4.26)cmH_(2)O,(15.03±2.74)cmH_(2)O vs.(16.45±3.21)cmH_(2)O;P_(ET)CO_(2):(30.59±1.57)mmHg(1 mmHg=0.133 kPa)vs.(32.04±2.11)mmHg,(35.02±4.15)mmHg vs.(39.88±4.76)mmHg,(35.90±4.22)mmHg vs.(40.11±4.87)mmHg,(34.33±4.17)mmHg vs.(37.65±2.69)mmHg;the C_(Ldyn) was significantly higher than that in VCV group:(40.6

关 键 词：结直肠肿瘤 血流动力学 结直肠外科手术 呼吸力学 生化代谢 

分 类 号：R735.34[医药卫生—肿瘤] R614[医药卫生—临床医学]