经皮肾镜取石术中采用压力控制容量保证通气模式对肺功能的影响

目的探讨压力控制容量保证通气模式(PCV-VG)在经皮肾镜取石术中对患者肺功能的影响。方法择期行经皮肾镜取石术患者40例,根据不同通气模式随机分为两组,每组20例,分别采用容量控制通气模式(V组)和PCV-VG(P组)。记录气管插管即刻(T0)、插管后15 min(T1)、30min(T2)、60min(T3)、120min(T4)的肺功能指标。结果 T2~T4时P组肺泡-动脉氧分压差(PA-aO2)、呼吸指数(RI)、吸气峰压(Ppk)、平台压(Pmean)明显低于V组(P0.05或P0.01),氧合指数(OI)、静态肺顺应性(Cst)明显高于V组(P0.05或P0.01)。结论 PCV-VG能够安全应用在经皮肾镜取石术,PCV-VG优于容量控制模式,术中有更低的气道压,血流动力学更平稳,更有利于对患者肺功能的保护。

Effects of volume-guaranteed pressure-regulated ventilation on the pulmonary function during percutaneous nephrolithotomy

Objective To observe the effects of pressure control ventilation with volume guar-antee (PCV-VG)on the pulmonary function during percutaneous nephrolithotomy procedures in pa-tients with general anesthesia.Methods Forty patients scheduled for percutaneous nephrolithotomy were selected and randomly allocated into PCV-VG group (n =20)and volume controlled ventilation (VCV)group (n =20).For two modes of ventilation,the goal tidal volume was 6-8 ml/kg,and the respiratory rate was contralled to 12-20 bpm.PA-a O 2 ,OI,RI,Ppk,Pmean,Cst,Hct,Lac were re-corded at intubation (T0 ),1 5 min (T1 ),30 min (T2 ),60 min (T3 ),and 120 min (L4 )after intuba-tion.Results PCV-VG resulted in significantly lower PA-a O 2 ,RI,Ppk,Pmean compared with VC ventilation (P < 0.05 or P < 0.01 ),and significantly higher OI,Cst versus VC ventilation (P <0.05 or P < 0.01).Conclusion In general anesthesia patients undergoing percutaneous nephrolithoto-my,PCV-VG is superior to VCV in terms of lower airway pressure and more stable hemodynamics, thus protects pulmonary function.