压力控制容量保证通气模式对腹腔镜疝修补术患儿呼吸力学及气体交换功能的影响

Effect of pressure controlled ventilation-volume guaranteed mode on respiratory mechanics and gas exchange function in pediatric patients undergoing laparoscopic herniorrhaphy

摘要:

目的 观察压力控制容量保证通气（PCV-VG）模式对腹腔镜疝修补术患儿呼吸力学和气体交换功能的影响。方法 选择该院择期行气管插管全身麻醉下腹腔镜疝修补术的患儿90例。随机数表法将患者分为PCV-VG组、压力控制通气（PCV）组和容量控制通气（VCV）组，每组30例。记录3组患儿人工气腹建立前5 min（T₁）、人工气腹建立后10 min（T₂）和气腹压力释放后5 min（T₃）的呼吸力学指标［吸入潮气量（VTinsp）、气道峰压（Ppeak）、平均气道压（Pmean）和动态肺顺应性（C_ldyn）］和气体交换指标［肺泡-动脉血氧分压差（P_A-aO₂）、呼吸指数（RI）和氧合指数（OI）］。记录3组患儿术后7 d内肺部并发症发生情况。结果 与VCV组比较，PCV-VG组和PCV组T₂和T₃时点Ppeak降低，C_ldyn升高，差异均有统计学意义（P < 0.05）；与PCV组比较，PCV-VG组T₂和T₃时点Ppeak降低，差异有统计学意义（P < 0.05）。与T₁时点比较，VCV组T₂和T₃时点Ppeak和Pmean升高，C_ldyn降低，PCV-VG组和PCV组T₂时点Ppeak和Pmean升高，C_ldyn降低，差异均有统计学意义（P < 0.05）。T₁、T₂和T₃时点，3组患儿P_A-aO₂、RI和OI比较，差异均无统计学意义（P > 0.05）；与T₁时点比较，3组患儿T₂和T₃时点P_A-aO₂和RI升高，OI降低，差异均有统计学意义（P < 0.05）。3组患儿术后并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 PCV-VG模式可有效地降低Ppeak，改善肺顺应性，适用于小儿腹腔镜疝修补术。

Abstract:

Objective To investigate the effects of pressure controlled ventilation-volume guaranteed (PCV-VG) mode on respiratory mechanics and gas exchange index in pediatric patients underwent laparoscopic herniorrhaphy.Methods 90 patients, scheduled for elective laparoscopic herniorrhaphy under general anesthesia of tracheal intubation,were randomly divided into 3 groups (n = 30 each) using a random number table method: PCV-VG group, pressure controlled ventilation (PCV) group and volume controlled ventilation (VCV) group. At 5 min before pneumoperitoneum (T₁), 10 min after pneumoperitoneum (T₂) and 5 min after release of pneumoperitoneum pressure (T₃), respiratory mechanical indexes [inspiratory tidal volume (VTinsp), peak airway pressure (Ppeak), mean airway pressure (Pmean), dynamic lung compliance (C_ldyn)] were recorded and gas exchange index [alveolar- artery oxygen partial pressure gradient (P_A-aO₂), respiratory index (RI) and oxygenation index (OI)] were recorded in three groups. The occurrence of pulmonary complications were recorded within 7 d after operation in three groups.Results Compared with the VCV group, Ppeak was significantly decreased and C_ldyn was significantly increased at T₂ and T₃ time points in PCV-VG group and PCV group, the differences were statistically significant (P < 0.05); Compared with PCV group, Ppeak was decreased at T₂ and T₃ time points in PCV-VG group, the difference was statistically significant (P < 0.05). Compared with T₁ time points, Ppeak and Pmean were increased and C_ldyn was decreased at T₂ and T₃ time points in VCV group, Ppeak and Pmean were increased and C_ldyn was decreased at T₂ in PCV-VG group and PCV group, the differences were statistically significant (P < 0.05). There were no significant differences in P_A-aO₂, RI and OI among three groups at T₁, T₂ and T₃ time points (P > 0.05). Compared with T₁ time point, P_A-aO₂ and RI were increased and OI was decreased at T₂ and T₃ time points in three groups, the differences were statistically significant (P < 0.05). There was no significant difference in the incidence of postoperative complications among the three groups (P > 0.05).Conclusion PCV-VG mode can effectively reduce Ppeak and improve lung compliance, which is suitable for laparoscopic herniorrhaphy in pediatric patients.