腹腔镜手术患儿压力控制通气和容量控制通气效果的比较

Objective To compare the efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery. Methods Thirty ASA Ⅰ or Ⅱ children of both sexes,aged 12-36 months, weighing 9-15 kg, scheduled for laparoscopic surgery, were randomly divided into 2 groups (n = 15 each): pressure-controlled ventilation group (group P) and volume-controlled ventilation group (group V) . Anesthesia was induced with propofol 2-4 mg/kg, vecuronium 0.1 mg/kg and fentanyl 2 μg/kg. The children were tracheal intubated and mechanically ventilated. The maximum inspiratory pressure was adjusted to make the tidal volume (VT ) achieve 12 ml/kg in group P and the VT was set at 12 ml/kg in group V. PETCO2 was maintained at 35-45 mm Hg. MAP, HR, PETCO2 , minute ventilation and peak airway pressure were recorded immediately after intubation (T0 ) , immediately before skin incision (T1 ) , 30 min of pneumoperitoneum (T2 ) and 15 min after the end of pneumoperitoneum (T3 ) . Arterial blood samples were taken at the same time points mentioned above for blood gas analysis. Dynamic lung compliance and physiological dead space to tidal volume ratio were calculated.Results Compared with group V, PaCO2 and PETCO2 were significantly decreased and dynamic lung compliance was significantly increased at T1,2 , and minute ventilation and peak airway pressure were significantly decreased at T0-3 in group P ( P < 0.01) . There was no significant difference in MAP, HR and physiological dead space to tidal volume ratio between the two groups ( P > 0.05) . Conclusion Compared with volume-controlled ventilation, pressure-controlled ventilation can better improve the ventilatory efficacy, is more beneficial to gas exchange and reduces the influence of pneumoperitoneum on respiratory function in children undergoing laparoscopic surgery.

Comparison of efficacy of pressure-controlled ventilation and volume-controlled ventilation in children undergoing laparoscopic surgery