比较腹腔镜下容量和压力控制通气对呼吸力学的影响

目的比较腹腔镜手术中两种机械通气病人相关呼吸力学的变化，并初步探讨呼吸力学监测在临床麻醉中的应用价值。方法选择ASA I～Ⅱ级，择期全麻下行腹腔镜手术的妇科病人60例，随机分为容量控制通气组（VCV组）和压力控制通气组（PCV组）。两组分别于气腹前5rain（T1）、气腹后5min（T2）、气腹后20rain（T3）、撤气腹前即刻（T4）及撤气腹后5rain（T5）记录气道峰压（Ppeak）、气道平台压（Pplat）、呼吸系统动态顺应性（Cdyn）、静态顺应性（Cstat）、机械通气的总阻力（Rtot）。结果PCV组T1时间点各指标与VcV组比较，差异无显著性（P2＞O．05）；T2、T3、T4、T5时间点Ppeak、Pplat、Rtot显著低于VCV组（t=2.01～3.54，P＜O．05）；T2、T3、T4、T5时间点Cdyn、Cstat高于vcv组（t=2．18～14．80，P＜O．05）。结论腹腔镜手术中PCV模式在保护呼吸系统顺应性方面优于VCV模式。

INFLUENCE OF VOLUME-CONTROLLED VERSUS PRESSURE-CONTROLLED VENTILATION ON RESPIRATORY MECHANICS DURING LAPAROSCOPIC SURGERY

Objective To compare the changes of ventilator-associated respiratory mechanics （VARM） of volume-controlled ventilation （VCV） and pressure-controlled ventilation （PCV） during laparoscopic surgery and preliminarily assess the value of monitoring respiratory mechanics in clinical anesthesia. Methods Sixty （ASA I-Ⅱ） patients with gynecopathia scheduled for elective laparoscopic surgery were evenly randomized to two groups as VCV and PCV. Peak airway pressure （Ppeak）, airway pre ssure （Pplat）, respiratory system dynamic compliance （Cdyn）, respiratory static compliance （Cstat）, and the total mechanical ventilation resistance （Rtot） were monitored separately during operation at five separate time points-namely 5 min before （T1）, 5 and 20 min after pneumoperitoneum （T2, T3）, immediately before （T4） and 5min after the withdrawal of pneumoperitoneum （Ts）. Results The markers at T1 between groups PCV and VCV were not statistically different （P〉0.05）. In PCV group, the Ppeak, Pplat, and Rtot at T2, T3, T4 , and T5 were lower than VCV group （t=2.01-3.54,P〈0.05）. Conclusion The pressure-controlled ventilation mode is superior than volume-controlled ventilation with regard to compliance of the respiratory system during laparoscopic surgery.