文章摘要
不同通气模式对腹腔镜下Trendelenburg体位患者肺通气的影响
Effects of different ventilation modes on lung ventilation in patients undergoing laparoscopic surgery in Trendelenburg position
  
DOI：10.12089/jca.2020.09.004
中文关键词: 电阻抗断层成像技术  Trendelenburg体位  肺通气  压力控制容量保证通气
英文关键词: Electrical impedance imaging technology  Trendelenburg position  Lung ventilation  Pressure-controlled ventilation-volumeguaranteed
基金项目:安徽省科技攻关项目（1704a0802165）；安徽高校自然科学研究项目(KJ2019ZD24)
作者单位E-mail
王冰洁 230601,合肥市,安徽医科大学第二附属医院麻醉科  
李云 230601,合肥市,安徽医科大学第二附属医院麻醉科  
王家友 230601,合肥市,安徽医科大学第二附属医院麻醉科  
蒋维维 230601,合肥市,安徽医科大学第二附属医院麻醉科  
张野 230601,合肥市,安徽医科大学第二附属医院麻醉科 zhangye_hassan@sina.com 
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中文摘要:
      
目的 采用电阻抗断层成像(EIT)技术观察容量控制通气(VCV)和压力控制容量保证通气(PCV-VG)模式对腹腔镜下Trendelenburg体位患者全麻术中肺通气的影响。
方法 择期全麻下行腹腔镜下Trendelenburg体位妇科手术患者60例，年龄40～65岁，BMI 18～30 kg/m2，ASA Ⅰ或Ⅱ级，采用随机数字表法将患者分为两组：VCV模式组（V组）和PCV-VG模式组（P组），每组30例。V组术中采用VCV模式，P组采用PCV-VG模式。记录入室后(T0)、插管后5 min(T1)、更改体位（由平卧位更改为Trendelenburg体位）后即刻(T2)、更改体位后30 min(T3)、更改体位后60 min(T4)、更改体位后120 min(T5)、改平卧位(T6)时的MAP、HR、通气中心(CoV)、依赖静止区(DSS)、非依赖静止区(NSS)的面积百分比。记录T1、T3—T5时气道峰压（Ppeak）、pH、PaO2、PaCO2、氧合指数（OI）。记录术后7 d内肺部感染、呼吸衰竭等肺部并发症发生情况。
结果 T0—T6时两组MAP、HR差异无统计学意义。与V组比较，T3—T6时CoV面积百分比明显升高，DSS面积百分比明显降低（P<0.05），T3—T5时Ppeak明显降低（P<0.05），T4、T5时PaO2、OI明显升高（P<0.05）。两组术后7 d内均无肺部并发症。
结论 PCV-VG通气模式可明显改善腹腔镜下Trendelenburg体位患者术中肺通气及肺氧合功能。
英文摘要:
      
Objective To observe the effects of volume controlled ventilation (VCV) and pressure-controlled ventilation-volumeguaranteed (PCV-VG) on lung ventilation during general anesthesia in patients undergoing laparoscopic surgery in Trendelenburg position by electrical impedance tomography (EIT).
Methods Sixty patients scheduled for elective laparoscopic gynecology surgery in Trendelenburg position, aged 40-65 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into volume-controlled ventilation group (group V) and pressure-controlled ventilation-volumeguaranteed group (group P), 30 cases in each group. MAP, HR, the percentages of area in center of ventilation (CoV), dependent silent spaces (DSS) and non-dependent silent spaces (NSS) were recorded at seven different time points: entering the room (T0) 5 min after tracheal intubation (T1), immediately after changing to the Trendelerlourg position (T2), 30 min after change the position (T3), 60 min after change the position (T4), 120 min after change the position (T5), change the supine position (T6). The airway peak pressure (Ppeak), pH, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), oxygenation index (OI) were recorded at T1, T3-T5, The incidences of postoperative pulmonary complications such as lung infection and respiratory failure within 7 days after operationwere also recorded.
Results There were no significant differences in MAP, HR between the two groups at T0-T6. Compared with group V, the CoV was significantly increased, the DSS was significantly decreased at T3-T6 in group P(P < 0.05). The Ppeak was significantly decreased at T3-T5 in group P (P < 0.05). The PaO2and the OI were significantly increased at T4-T5 in group P (P < 0.05). No pulmonary complications occurred within 7 days after operation in both groups.
Conclusion Compared with VCV, PCV-VG can significantly improve intraoperative lung ventilation and pulmonary oxygenation in patients undergoing laparoscopic surgery in Trendelenburg position.
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