压力控制容量保证通气模式在新生儿胸腔镜食管闭锁手术中的应用  

Application of pressure-controlled ventilation-volume guaranteed ventilation mode in neonatal thoracoscopic esophageal atresia surgery

作　　者：杨海扣[1] 强强 周士三[1] 张浩[1] 孙剑[1] YANG Haikou;QIANG Qiang;ZHOU Shisan;ZHANG Hao;SUN Jian(Department of Anesthesiology,Huai'an Maternal and Child Health Care Center,Huai'an 223002,China)

机构地区：[1]江苏省淮安市妇幼保健院麻醉科,223002

出　　处：《临床麻醉学杂志》2024年第2期155-159,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨在新生儿胸腔镜食管闭锁手术中应用压力控制容量保证通气(PCV-VG)模式的通气效果及应用安全性。方法选择全麻下行胸腔镜食管闭锁手术新生儿36例,男22例,女14例,日龄1~4 d,体重1.4~4.5 kg,ASAⅢ或Ⅳ级。采用随机数字表法将新生儿分为两组:PCV-VG模式组(P组)和容量控制通气(VCV)模式组(V组),每组18例。麻醉成功后P组和V组分别使用PCV-VG模式和VCV模式。记录气管插管前、单肺通气前10 min、单肺通气后30 min、单肺通气结束后10 min的MAP、HR、SpO_(2)。记录单肺通气前10 min、单肺通气后30 min、单肺通气结束后10 min的气道平均压(Pmean)、气道峰压(Ppeak)、吸气平台压(Pplat)、肺动态顺应性(Cdyn)、P_(ET)CO_(2)、PaCO_(2)、PaO_(2)和pH。记录术后气管导管拔除时间和ICU停留时间。结果与V组比较,单肺通气后30 min P组SpO_(2)、Cdyn、PaO_(2)和pH明显升高(P<0.05),Pmean、Ppeak、Pplat明显降低(P<0.05);单肺通气后30 min和单肺通气结束后10 min P组P_(ET)CO_(2)、PaCO_(2)明显降低(P<0.05)。与V组比较,P组术后气管导管拔除时间和ICU停留时间明显缩短(P<0.05)。结论在新生儿胸腔镜食管闭锁手术中,与VCV模式比较,使用PCV-VG模式可以降低气道压力,提高肺顺应性,改善术中肺部气体交换,有利于新生儿术后康复。Objective To investigate the ventilation effect and application safety of pressure-controlled ventilation-volume guaranteed(PCV-VG)mode in neonatal thoracoscopic esophageal atresia surgery.Methods Thirty-six newborns who underwent thoracoscopic esophageal atresia surgery under general anesthesia,22 males and 14 females,aged 1-4 days,weighing 1.4-4.5 kg,ASA physical statusⅢorⅣ,were divided into two groups using a random number table method:the PCV-VG mode group(group P)and the volume-controlled ventilation(VCV)mode group(group V),18 newborns in each group.After anesthesia,PCV-VG and VCV ventilation modes were employed for mechanical ventilation in groups P and V,respectively.The MAP,HR,and SpO_(2) were recorded prior to tracheal intubation,10 minutes before one-lung ventilation(OLV),30 minutes after OLV,and 10 minutes after completion of OLV.Additionally,the Pmean,Ppeak,Pplat,Cdyn,P ET CO_(2),PaCO_(2),PaO_(2),and pH were monitored 10 minutes before OLV,30 minutes after OLV,and 10 minutes after completion of OLV.The time of tracheal tube removal after surgery and the duration of ICU retention were also observed.Results Compared with group V,the SpO_(2),Cdyn,PaO_(2),and pH levels showed a significant increase,while significant decrease were noted in Pmean,Ppeak,and Pplat in group P 30 minutes after OLV(P<0.05).Compared with group V,the P ET CO_(2) and PaCO_(2) in group P decreased significantly 30 minutes after OLV and 10 minutes after completion of OLV.Besides,compared with group V,the time of tracheal tube removal after surgery and the duration of ICU retention were also significantly shortened in group P(P<0.05).Conclusion The utilization of PCV-VG ventilation mode in neonatal thoracoscopic esophageal atresia surgery,as compared to VCV ventilation mode,can effectively reduce airway pressure,enhance lung compliance,optimize intraoperative lung gas exchange,and facilitate postoperative recovery of the neonates.

关 键 词：食管闭锁 胸腔镜 压力控制容量保证通气 容量控制通气 新生儿 单肺通气 

分 类 号：R726.1[医药卫生—儿科]