腹腔镜手术中容量控制通气与压力控制通气量的比较在头低脚高的位置 Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position
Highlights 亮点 •We compared PCV-VG and VCV on respiratory mechanics during laparoscopic surgery. • PCV-VG had significantly lower PIP and greater dynamic compliance than VCV group. • PCV-VG has the advantage to lower incidence of barotrauma. •比较对呼吸力学pcv-vg和VCV在腹腔镜手术。 • pcv-vg比VCV组显著降低PIP和更大的动态顺应性。 • pcv-vg有气压伤发生率低的优点。
Abstract 摘要 Study objective 研究目的 To analyze the effects of pressure-controlled ventilation-volume guaranteed (PCV-VG) and volume controlled ventilation (VCV) on airway pressures and respiratory and circulatory indicators during laparoscopic surgery in Trendelenburg position. 分析压力控制通气量保证的效果(pcv-vg)和容量控制通气(VCV)对气道压力和呼吸循环在在头低脚高的位置在腹腔镜手术指标。
Design 设计 Prospective randomized comparative clinical study. 前瞻性随机对照临床研究。
Setting 环境 Tertiary hospital. 三级医院。
Patients 患者 Forty ASA physical status 1 and 2 patients who underwent elective laparoscopic surgery in Trendelenburg position. 四十例择期行腹腔镜手术的1例和2例患者的身体状况在头低脚高的位置。
Interventions 干预 Patients were randomly allocated to either VCV group (n = 20) or the PCV-VG group (n = 20). After induction of anesthesia, for both modes of ventilation, the target tidal volume (VT) was 8 mL/kg and the respiratory rate was adjusted to avoid hypercarbia. 患者被随机分配到VCV组(n = 20 )或pcv-vg组(n = 20 )。麻醉诱导后,为通风模式,目标潮气量(VT)为8 ml/kg,呼吸频率调整以避免高碳酸血症。
Measurements 测量 The peak and mean inspiratory pressures, dynamic compliance, exhaled VT, oxygenation index and physiological dead space were calculated and recorded at T1, 5 minutes after induction of anesthesia in supine position, T2, 5 minutes after stabilization of pneumoperitoneum, T3 and T4, 15 and 60 minutes after 30° Trendelenburg position with pneumoperitoneum respectively. 峰值和平均吸气压力,动态顺应性,呼出VT,计算并记录在T1氧合指数、生理死腔,5 分钟麻醉仰卧,T2的诱导后,5分钟稳定 气腹后,分别在T3、T4、15、60 分钟30°体位和气腹后。
Main results 主要结果 PCV-VG group had significantly lower peak inspiratory pressure and greater dynamic compliance than VCV group (P < .001). pcv-vg组有显着降低吸气峰压和大动态顺应性比VCV组(P< 。001)。
Conclusions 结论 In patients who underwent laparoscopic surgery in Trendelenburg position, PCV-VG was superior to VCV in its ability to provide ventilation with lower peak inspiratory pressure and greater dynamic compliance. 患者行腹腔镜手术在头低脚高的位置,pcv-vg优于VCV在其提供通风降低吸气峰压和大动态顺应性能力。
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