PCV-VG模式对Trendelenburg体位腹腔镜结肠手术老年患者肺通气的影响

  目的  观察压力控制容量保证通气(PCV-VG)对Trendelenburg体位腹腔镜结肠手术老年患者肺通气的影响。  方法  选择2020年5月—2021年4月温州市中西医结合医院结肠手术患者60例，以随机数字表法分为容量控制通气组(V组)30例和PCV-VG组(P组)30例。记录各时点(T1~T6)的平均动脉压(MAP)、心率(HR)、动态肺顺应性(Cdyn)、气道峰压(Ppeak)、气道平台压(Pplat)和呼气末二氧化碳分压(PetCO₂)。记录术中pH、PaO₂及PaCO₂, 计算氧合指数(OI)，观察术后5 d内肺部并发症情况。  结果  2组患者组间各时点MAP及HR差异无统计学意义，2组T1~T6的HR均比T0增加(均P＜0.05)。与T1比较，2组患者T4和T5时pH降低。随体位变换时间增加，2组患者PaO₂下降，PaCO₂上升，OI下降(均P＜0.05)。在T5时，组间比较，V组PaO₂及OI低于P组。在T3~T6，V组Ppeak及Pplat升高，Cdyn下降；T4~T5，P组Cdyn下降。在T5时，V组Ppeak值(25.4±2.1)cm H₂O vs. (16.3±2.1)cm H₂O，1 cm H₂O=0.098 kPa]、Pplat值(9.0±0.5) cm H₂O vs. (7.0±0.6)cm H₂O]高于P组，Cdyn值(33.2±6.3) mL/cm H₂O vs. (40.3±5.2)mL/cm H₂O]低于P组。P组高碳酸血症发生率3.3%(1/30)]比V组23.3%(7/30)]低，差异无统计学意义(χ2=3.606，P=0.057)。  结论  PCV-VG适用于腹腔镜下Trendelenburg体位结肠手术老年患者，可降低气道压，提高氧合指数，减少术后并发症。 

Effect of pressure-controlled ventilation-volume guaranteed on lung ventilation in elderly patients undergoing laparoscopic Trendelenburg postural colon surgery

  Objective  To observe the effect of pressure-controlled ventilation volume guaranteed (PCV-VG) on lung ventilation in elderly patients undergoing Trendelenburg position laparoscopic colon surgery.  Methods  Total 60 patients with colon surgery in Wenzhou Integrated Traditional Chinese and Western Medical Hospital from May 2020 to April 2021 were randomly divided into volume control ventilation group (V group, n=30) and PCV-VG group (P group, n=30).The mean arterial pressure (MAP), heart rate (HR), dynamic compliance (Cdyn), inspiratory peak pressure (Ppeak), plateau airway pressure (Pplat) and the partial pressure of end- tidal carbon dioxide (PetCO₂) were recorded at different time point (T1-T6). The pH, PaO₂ and PaCO₂ were determined by blood gas analysis and oxygenation index (OI) and pulmonary complications were calculated within 5 days after operation.  Results  There was no statistical significance in MAP and HR between V and P group. The HR at T1-T6 in both groups was higher than that in T0 (P < 0.05). Patients in both groups with T4 and T5 had lower PH compared to T1. The PaO₂ and OI decreased and PaCO₂ increased in both group with the increase in body position change time (P < 0.05). In T5, compared with P group, the PaO₂ and OI values were decreased while PaCO₂ values increased in V group. At T3-T6, Ppeak and Pplat were increased and Cdyn decreased in V group compared with p group. The Cdyn at T4-T5 in P group was decreased compared with V group. At the time point of T5: Ppeak value was (25.4±2.1) cm H₂O (1 cm H₂O=0.098 kPa) in V group vs. (16.3±2.1) cm H₂O in P group; the Pplat value was (9.0±0.5) cm H₂O in V group vs. (7.0±0.6) cm H₂O in P group, and the Cdyn value was (33.2±6.3) mL/cm H₂O in V group vs. (40.3±5.2) mL/cm H₂O in P group. The percentage of hypercapnia in group P (3.3%, 1/30) was lower than that in group V (23.3%, 7/30), but the difference was not statistically significant (χ2=3.606, P=0.057).  Conclusion  PCV-VG can effectively reduce airway pressure of lung ventilation, improve oxygenation index and reduce postoperative complications for elderly patients undergoing laparoscopic Trendelenburg colon surgery.