压力调节容积控制通气模式对合并慢性阻塞性肺疾病腹腔镜结直肠手术患者肺保护效应

目的:探讨压力调节容积控制通气（pressure-regulated volume control, PRVC）模式下肺保护性通气（lung-protective ventilation, LPV）对合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）腹腔镜结直...

Effects of pressure-regulated volume control ventilation on the lung in patients with chronic obstructive pulmonary disease during laparoscopic colorectal surgery

Objective To discuss the effects of lung-protective ventilation(LPV)under pressure-regulated volume control(PRVC)model on the lung in patients with chronic obstructive pulmonary disease(COPD)during laparoscopic colorectal surgery.Methods A total of 50 patients with moderate COPD,aged 52 to 70 years,with body mass index(BMI)<30 kg/m2,American Society of Anesthesiologists(ASA)ⅡorⅢ,were enrolled,who were scheduled for laparoscopic radical resection of colorectal cancer under general anesthesia.According to the random number table and double blind methods,the patients were divided into two groups(n=25):a lung-protective ventilation group(group LPV)and a PRVC combined with LPV group(group PRVC).Then,the radial artery blood samples were collected for blood gas analysis before anesthesia induction(T0),10 min after intubation(T1),60 min after pneumoperitoneum(T2),and 10 min after the end of pneumoperitoneum(T3).Meanwhile,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2)and alveolar-arterial oxygen difference(PA-aO2)were recorded,and the respiratory index(RI)was calculated.The airway peak pressure(Ppeak)and the airway platform pressure(Pplat)at T1,T2,and T3 were recorded,while dynamic pulmonary compliance(Cdyn)was recorded.The forced expiratory volume in one second(FEV1),forced vital capacity(FVC),FEV1/FVC,and residual volume/total lung capacity(RV/TLC)1,3 and 5 days after surgery were measured.The incidence of complications(pneumonia,atelectasis,and respiratory failure,etc)during surgery and 7 days after surgery,as well as clinical pulmonary infection score(CPIS)2 and 5 days after surgery and discharge time were recorded.Results Compared with group LPV,group PRVC presented increases in PaO2(P<0.05)and decreases in PA-aO2 and RI at T3(P<0.05).Compared with group LPV,group PRVC produced decreased Ppeak and Pplat(P<0.05),as well as increased Cdyn at T1,T2 and T3(P<0.05).Compared with group LPV,group PRVC showed increases in FEV1 and FVC(P<0.05)as well as decreases in RV/TLC(P<0.05)1 day after surgery,and increases in FEV13 days after surgery(P<0.05).Compared with group LPV,group PRVC presented decreased CPIS scores 2 and 7 days after surgery(P<0.05).There was no statistical difference in other indicators.Conclusions Under the PRVC model,LPV strategy can improve pulmonary oxygenation function and Cdyn in COPD patients during laparoscopic colorectal surgery,and optimize lung protection effects.