两种通气模式对后腹腔镜手术患者循环呼吸功能的影响

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摘要目的: 观察定容通气和定压通气两种通气模式对后腹腔镜手术患者人工CO2气腹期间呼吸力学和氧合的影响。方法: 将泌尿外科择期行后腹腔镜手术患者40例，随机分为定容通气组和定压通气组，每组20例。所有患者静吸复合麻醉气管插管后，定容通气组全程采用定容通气，定压通气组患者于人工气腹即刻由定容通气转为定压通气。持续监测动脉收缩压(ABP)、平均动脉压(MAP)、心率、气道峰压、气道平台压(Pplat)、呼气末CO2分压（PETCO2）以及肺顺应性。分别于麻醉前5 min(T0)、人工气腹即刻(T1)和气腹开始后30 min(T2)、60 min(T3)、90 min(T4)以及气腹结束15 min(T5)，采集动脉血进行血气分析。结果：与T1比较，T2、T3、T4 时点两组气道峰压、Pplat、PETCO2和无效腔量与潮气量比值（Vd/Vt值）均明显升高，肺顺应性均明显下降(P＜0.05)；定压通气组T2、T3、T4 时点气道峰压、Vd/Vt值、肺泡动脉血氧分压差（AaDO2）、呼吸指数及肺内分流率（Qs/Qt）均明显低于定容通气组，PaO2和氧合指数均明显高于定容通气组(均P＜0.05)。与T0比较，T1、T2、T3、T4 时点两组PaO2、SaO2值、AaDO2、氧合指数及Qs/Qt值均显著升高(均P＜0.05)，呼吸指数均显著降低(均P＜0.05)，T2、T3、T4 时间点两组PaCO2、血乳酸值均明显升高、pH值均明显下降(均P＜0.05)；两组间SaO2、PaCO2、血乳酸及pH值在各时间点差异没有统计学意义(P＞0.05)。结论：与定容通气模式相比，后腹腔镜手术患者人工CO2气腹期间采用定压通气模式可提供更好的氧合条件。

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关键词 ：后腹腔镜手术, 人工CO2气腹, 定容通气, 定压通气

Abstract：Objective: To explore the effects of two different ventilatory modes: volumecontrolled ventilation(VCV) and pressurecontrolled ventilation(PCV) on the pulmonary mechanics and arterial oxygenation in patients during pneumoperitoneum. Methods: Forty patients were enrolled who underwent retroperitoneoscopic urological surgery.All patients were started with VCV.After intubation, they were randomized to receive either VCV(n=20) or PCV(n=20). Arterial blood gas analyses were done at 5 min before anesthesia(T0),the creation of pneumoperitoneum(T1),30 min after pneumoperitoneum(T2),60 min after pneumoperitoneum(T3),90 min after pneumoperitoneum(T4), and 15 min after deflation(T5). Hemodynamic and respiratory variables were recorded at various time. Results: The peak airway pressure(Ppeak),airway plateau pressure(Pplat),the end tidal carbon dioxide pressure(PETCO2) and Vd/Vt were increased, while pulmonary compliance(Cdyn) were decreased(P＜0.05) during pneumoperitoneum in both two groups.The levels of Ppeak and Vd/Vt were significantly lower in group PCV(P＜0.05) during the pneumoperitoneum compared with that of group VCV.The PaCO2 and blood lactate(Lac) were increased, whereas pH were decreased(P＜0.05) in both two groups after pneumoperitoneum established.The PaO2,SaO2, AaDO2 ,oxygen index(OI) and intrapulmonary shunt(Qs/Qt) had risen significantly, while respiration index(RI) decreased markedly(P＜0.05) in both two groups after pneumoperitoneum established.Compared with that of group VCV,PaO2 and OI were higher, whereas AaDO2, RI and Qs/Qt were lower(P＜0.05) in group PCV after pneumoperitoneum. Conclusion: Compared with VCV,PCV is a more effective mode of ventilation in providing better intraoperative oxygenation for patients undergoing retroperitoneoscopic urological surgery.

收稿日期: 2017-02-23

作者简介: 顾珍（1991—），女，硕士研究生

引用本文:

顾珍1，朱敏敏2. 两种通气模式对后腹腔镜手术患者循环呼吸功能的影响[J]. 江苏大学学报:医学版, 2017, 27(02): 137-141. GU Zhen1, ZHU Min-min2. Effect of two types of mechanical ventilation modes on patients undergoing retroperitoneoscopic urological surgery in cardiorespiratory function. Journal of Jiangsu University(Medicine Edition), 2017, 27(02): 137-141.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2017/V27/I02/137

[1\]Freitas PF,Dures LC,Carvalho FA,et al.Effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in rats\[J\]. Acta Cir Bras,2013,28(7): 494-498.
\[2\]BalickWeber CC,Nicolas P,HedrevilleMontout M,et al. Respiratory and haemodynamic effects of volumecontrolled vs pressurecontrolled ventilation during laparoscopy: a crossover study with echocardiographic assessment\[J\]. Br J Anaesth,2007,99(3):429-435.
\[3\]刘杰,陈荣昌.生理死腔与潮气量比率测定的临床研究进展\[J\].国际呼吸杂志,2007， 27(20):1588-1592.
\[4\]Park JS,Ahn EJ,Ko DD, et al. Effects of pneumoperitoneal pressure and position changes on respiratory mechanics during laparoscopic colectomy\[J\].Korean J Anesthesiol, 2012,63(5): 419-424.
\[5\]Dion JM,McKee C,Tobias JD, et al. Ventilation during laparoscopicassisted bariatric surgery:volumecontrolled,pressurecontrolled or volumeguaranteed pressureregulated modes\[J\].Int J Clin Exp Med,2014,7(8):2242-2247.
\[6\]Gupta SD, Kundu SB, Ghose T, et al. A comparison between volumecontrolled ventilation and pressurecontrolled ventilation in providing better oxygenation in obese patients undergoing laparoscopic cholecystectomy\[J\].Indian J Anaesth,2012,56(3):276-282.
\[7\]Almarakbi WA, Fawzi HM, Alhashemi JA. Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients\[J\]. Br J Anaesth,2009,102(6):862-868.
\[8\]Lorenzo AJ,Karsli C,Halachmi S,et al.Hemodynamic and respiratory effects of pediatric urological retroperitoneal laparoscopic surgery: a prospective study\[J\]. J Urol,2006,175(4):1461-1465.
\[9\]Kwak HJ,Jo YY,Lee KC,et al.Acidbase alterations during laparoscopic abdominal surgery: a comparison with laparotomy\[J\].Br J Anaesth,2010,105(4): 442-447.
\[10\]Cadi P,Guenoun T,Journois D,et al.Pressurecontrolled ventilation improves oxygenation during laparoscopic obesity surgery compared with volumecontrolled ventilation\[J\]. Br J Anaesth,2008,100(5): 709-716.
\[11\]吴裕超，孙志鹏，向强,等.不同吸入氧浓度对新生儿肺泡—动脉氧分压差的影响\[J\].广东医学,2013,34(1):70-72.
\[12\]Rusca M, Proietti S,Schnyder P,et al.Prevention of atelectasis formation during induction of general anesthesia\[J\]. Anesth Analg,2003,97(6):1835-1839.