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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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.

Received: 23 February 2017

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http://zzs.ujs.edu.cn/xbyxb/EN/ OR http://zzs.ujs.edu.cn/xbyxb/EN/Y2017/V27/I02/137

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