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Effect of two types of mechanical ventilation modes on patients undergoing retroperitoneoscopic urological surgery in cardiorespiratory function |
GU Zhen1, ZHU Min-min2 |
(Department of Anesthesia, the Affiliated Wuxi Second Hospital of Nanjing Medical University, Wuxi Jiangsu 214002, China) |
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Abstract Objective: To explore the effects of two different ventilatory modes: volumecontrolled ventilation(VCV) and pressurecontrolled 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, AaDO2 ,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 AaDO2, 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.
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Received: 23 February 2017
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[1\]Freitas PF,Dures 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.\[2\]BalickWeber CC,Nicolas P,HedrevilleMontout M,et al. Respiratory and haemodynamic effects of volumecontrolled vs pressurecontrolled ventilation during laparoscopy: a crossover 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 laparoscopicassisted bariatric surgery:volumecontrolled,pressurecontrolled or volumeguaranteed pressureregulated modes\[J\].Int J Clin Exp Med,2014,7(8):2242-2247.\[6\]Gupta SD, Kundu SB, Ghose T, et al. A comparison between volumecontrolled ventilation and pressurecontrolled 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 retroperitoneal laparoscopic surgery: a prospective study\[J\]. J Urol,2006,175(4):1461-1465.\[9\]Kwak HJ,Jo YY,Lee KC,et al.Acidbase 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.Pressurecontrolled ventilation improves oxygenation during laparoscopic obesity surgery compared with volumecontrolled 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. |
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