摘要
目的探究在腹腔镜袖状胃切除术中,应用压力控制容量保证通气(PCV-VG)模式对病态肥胖病人呼吸力学及气体交换功能的影响。方法选取2020年5―12月徐州医科大学附属医院腹腔镜袖状胃切除术病人80例,分为压力控制容量保证组(P组)和容量控制组(V组)。记录插管后5 min(T_(1))、建立气腹后30 min(T_(2))、60 min(T_(3))、撤气腹后5 min(T_(4))的气道峰压(P_(peak))、气道平均压(P_(mean))、肺动态顺应性(Cdyn)、潮气量(TV)、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2)),动脉氧饱和度(SaO_(2))并计算氧合指数(OI)、动脉-呼气末二氧化碳分压差(P_(a-ET)CO_(2))、肺泡-动脉血氧分压差(P_(a-A)O_(2))、死腔率(V_(D)/V_(T)),术后3 d肺部并发症发生率。结果排除剔除病例后,72例病人纳入最终分析,每组36例。在T_(1)、T_(2)、T_(3)、T_(4)时点,P组的P_(peak)[(20.69±3.61)mmHg、(23.72±3.64)mmHg、(24.11±3.89)mmHg、(21.08±3.48)mmHg]均低于V组[(22.33±3.18)mmHg、(28.17±3.03)mmHg、(28.78±2.67)mmHg、(22.56±2.51)mmHg](P<0.05)。与V组比较,P组P_(mean)、Cdyn在T_(2)、T_(3)时更高(P<0.05),T_(4)时PaO_(2)、OI明显增高,P_(a-A)O_(2)降低(P<0.05),P_(a-ET)CO_(2)、PaCO_(2)和V_(D)/V_(T)分别在T_(2)~T_(4)和T_(3)~T_(4)更低(P<0.05);两组SaO_(2)、TV和术后肺部并发症发生率相当(P>0.05)。结论与容量控制通气(VCV)模式相比,PCV-VG模式在为病态病人提供稳定潮气量的同时,能降低气道峰压,提高肺顺应性,改善氧合功能。
Objective To investigate the effects of pressure-controlled volume-guaranteed ventilation(PCV-VG)on respiratory me-chanics and gas exchange function in morbidly obese patients during laparoscopic sleeve gastrectomy.Methods A total of 80 patients who underwent laparoscopic sleeve gastrectomy in the Affiliated Hospital of Xuzhou Medical University from May to December 2020 were selected and divided into the PCV-VG group(group P)and the volume-controlled ventilation(VCV)group(group V).The peak air-way pressure(P_(peak)),mean airway pressure(P_(mean)),pulmonary dynamic compliance(Cdyn),tidal volume(TV),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2)),calculated oxygenation index(OI),arterial-end-tidal carbon dioxide partial pressure difference(Pa-ETCO_(2)),alveolar-arterial oxygen partial pressure difference(Pa-AO_(2)),dead space rate(VD/VT)were recorded 5 minutes after intubation(T_(1)),30 minutes(T_(2)),60 minutes(T_(3)),and 5 minutes after the pneu-moperitoneum was withdrawn(T_(4)).The incidence of pulmonary complications at 3 days after the operation was recorded.Results After exclusion,72 patients were included in the final analysis,with 36 cases in each group.At T_(1),T_(2),T_(3),and T_(4),the Ppeak[(20.69±3.61)mmHg,(23.72±3.64)mmHg,(24.11±3.89)mmHg,(21.08±3.48)mmHg]in group P was lower than that in group V[(22.33±3.18)mmHg,(28.17±3.03)mmHg,(28.78±2.67)mmHg,(22.56±2.51)mmHg](P<0.05).Compared with group V,group P had higher P_(mean) and Cdyn at T_(2)and T_(3)(P<0.05);higher PaO_(2)and OI at T_(4);and lower P_(a-A)O_(2)(P<0.05);Pa-ETCO_(2),PaCO_(2)and VD/VT were lower in at T_(2)~T_(4)and T_(3)~T_(4),respectively(P<0.05);and the incidence of SaO_(2),TV and postoperative pulmonary complications were comparable be-tween the two groups(P>0.05).Conclusion Compared with the volume controlled ventilation(VCV)mode,the PCV-VG mode can re-duce peak airway pressure,improve lung compliance,and improve oxygenation function while pro
作者
马晓彤
陈燕琪
宋雨童
颜明
MA Xiaotong;CHEN Yanqi;SONG Yutong;YAN Ming(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)
出处
《安徽医药》
CAS
2022年第11期2270-2274,共5页
Anhui Medical and Pharmaceutical Journal
关键词
呼吸
人工
正压呼吸
压力控制容量保证通气
病态肥胖
腹腔镜袖状胃切除术
呼吸力学
气体交换
Respiration
artificial
Positive-pressure respiration
Pressure-controlled ventilation with volume-guaranteed
Morbid obesity
Laparoscopic sleeve gastrectomy
Respiratory mechanics
Gas exchange
