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

诸光峰; 王和节; 蒋毅; 顾叶春; 李奕铮

doi:10.16766/j.cnki.issn.1674-4152.002542

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

doi: 10.16766/j.cnki.issn.1674-4152.002542

温州市中西医结合医院麻醉科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2021KY1081

温州市医药卫生科研项目 2018A04

详细信息

通讯作者:
诸光峰, E-mail: zcw58989@126.com

中图分类号: R614 R735.35
计量
- 文章访问数: 245
- HTML全文浏览量: 83
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-10-12
- 网络出版日期: 2022-09-23

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

Department of Anesthesiology, Wenzhou Integrated Traditional Chinese and Western Medical Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 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。
- 通气模式，压力控制容量保证通气 /
- 体位, Trendelenburg /
- 结肠手术 /
- 老年人 /
- 肺通气
Abstract: 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.
- Ventilation mode, Pressure-controlled ventilation volume guaranteed /
- Position, Trendelenburg /
- Colon surgery /
- Elderly /
- Lung ventilation

HTML全文

表 1 2组腹腔镜结肠癌根治术患者一般情况比较

Table 1. The general situation of patients undergoing laparoscopic radical resection of colon cancer was compared between two groups

组别	例数	性别(例)		ASA分级(例)		年龄(x±s，岁)	体重(x±s，kg)	手术时间(x±s，min)	气腹时间(x±s，min)	出血量(x±s，mL)
组别	例数	男性	女性	Ⅰ级	Ⅱ级	年龄(x±s，岁)	体重(x±s，kg)	手术时间(x±s，min)	气腹时间(x±s，min)	出血量(x±s，mL)
V组	30	19	11	21	9	72.3±7.4	62.8±9.3	180.6±31.2	141.4±25.3	116.5±17.4
P组	30	17	13	20	10	71.6±6.8	61.5±10.2	173.3±29.5	140.9±23.4	114.3±18.4
统计量		0.278^a		0.077^a		0.382^b	0.516^b	0.931^b	0.079^b	0.411^b
P值		0.598		0.781		0.704	0.608	0.356	0.937	0.683
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组腹腔镜结肠癌根治术患者MAP和HR比较(x±s)

Table 2. Comparison of perioperative MAP and HR between the two groups

组别	例数	MAP(mm Hg)
组别	例数	T0	T1	T2	T3	T4	T5	T6
V组	30	90.1±12.4	91.0±13.6	94.2±13.2	90.8±12.4	91.8±12.0	92.0±10.4	90.5±12.0
P组	30	91.0±12.2	92.0±12.3	95.1±13.6	90.3±12.1	91.3±11.1	90.8±12.0	91.4±12.3
t值		-0.283	-0.299	-0.260	0.158	0.168	0.414	-0.287
P值		0.778	0.766	0.796	0.875	0.867	0.680	0.775

组别	例数	HR(次/min)
组别	例数	T0	T1	T2	T3	T4	T5	T6
V组	30	83.3±10.4	88.3±10.5^a	90.0±11.1^a	87.1±11.4^a	86.1±11.0^a	87.6±10.3^a	87.5±11.4^a
P组	30	82.2±11.2	90.1±11.0^a	91.1±15.3^a	90.3±12.1^a	89.3±12.7^a	90.4±11.0^a	91.0±12.2^a
t值		0.394	-0.648	-0.319	-1.054	-1.043	-1.018	-1.148
P值		0.695	0.519	0.751	0.296	0.301	0.313	0.256
注：与T0比较，^aP＜0.05。

下载: 导出CSV

表 3 2组腹腔镜结肠癌根治术患者血气分析指标及氧合指数比较(x±s)

Table 3. Comparison of blood gas analysis index and oxygenation index between two groups of patients undergoing laparoscopic radical resection of colon cancer

组别	例数	pH				PaO₂(mm Hg)
组别	例数	T1	T3	T4	T7	T1	T3	T4	T7
V组	30	7.45±0.05	7.39±0.04^a	7.37±0.03^a	7.35±0.04^a	262.4±26.5	253.3±25.1^a	235.7±23.0^a	223.7±24.1^a
P组	30	7.43±0.04	7.41±0.06^a	7.38±0.05^a	7.36±0.03^a	264.5±27.2	261.2±25.3^a	251.4±22.4^a	245.2±24.5^a
t值		1.711	-1.519	-0.939	-1.095	-0.303	-1.214	-2.678	-3.427
P值		0.092	0.134	0.352	0.278	0.763	0.230	0.010	0.001

组别	例数	PaCO₂(mm Hg)				OI(mm Hg)
组别	例数	T1	T3	T4	T7	T1	T3	T4	T7
V组	30	37.4±6.2	41.0±7.1^a	48.0±7.5^a	49.1±6.3^a	430.5±25.4	424.5±25.5^a	407.0±26.6^a	384.2±26.1^a
P组	30	36.0±6.0	39.1±6.2^a	45.1±7.0^a	46.2±5.5^a	429.0±25.3	425.2±25.1^a	420.9±26.4^a	414.6±25.2^a
t值		0.889	1.104	1.548	1.899	0.229	-0.107	-2.031	-4.589
P值		0.378	0.274	0.127	0.062	0.820	0.915	0.047	＜0.001
注：与T1比较，^aP＜0.05。

下载: 导出CSV

表 4 2组腹腔镜结肠癌根治术患者呼吸力学指标比较(x±s)

Table 4. Comparison of respiratory mechanics indexes between the two groups

组别	例数	Ppeak(cm H₂O)
组别	例数	T1	T2	T3	T4	T5	T6
V组	30	14.4±2.0	17.1±2.2^a	19.3±2.1^a	22.1±2.0^a	25.4±2.1^a	20.0±2.0^a
P组	30	14.3±2.1	15.3±2.1^a	15.5±1.9^a	16.3±2.1^a	16.3±2.1^a	14.5±2.1^a
t值		0.189	3.242	7.349	10.954	16.783	10.388
P值		0.851	0.002	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	Pplat(cm H₂O)
组别	例数	T1	T2	T3	T4	T5	T6
V组	30	6.4±0.3	6.8±0.7^a	7.7±0.5^a	8.7±0.6^a	9.0±0.5^a	7.9±0.7^a
P组	30	6.6±0.5	6.7±0.4^a	6.7±0.7^a	7.0±0.4^a	7.0±0.6^a	6.7±0.5^a
t值		-1.879	0.679	6.367	12.912	14.026	7.641
P值		0.065	0.501	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	Cdyn(mL/cm H₂O)
组别	例数	T1	T2	T3	T4	T5	T6
V组	30	47.4±6.6	43.0±7.1^a	37.0±7.5^a	35.1±6.5^a	33.2±6.3^a	39.1±6.3^a
P组	30	46.0±6.4	45.1±6.2^a	43.1±6.0^a	41.4±5.5^a	40.3±5.2^a	45.2±5.3^a
t值		0.834	-1.220	3.479	-4.053	-4.761	-4.058
P值		0.408	0.227	＜0.001	＜0.001	＜0.001	＜0.001
注：与T1比较，^aP＜0.05；1 cm H₂O=0.098 kPa。

下载: 导出CSV

参考文献(15)

[1]	KIM Y S, WON Y J, LEE D K, et al. Lung ultrasound score-based perioperative assessment of pressure-controlled ventilation-volume guaranteed or volume-controlled ventilation in geriatrics: A prospective randomized controlled trial[J]. Clin Interv Aging, 2019, 14: 1319-1329. doi: 10.2147/CIA.S212334
[2]	李颖, 张铁峰, 蒋海斌, 等. 肺保护性通气用于老年腹腔镜结直肠癌手术患者的临床观察[J]. 中华全科医学, 2019, 17(10): 1673-1677. doi: 10.16766/j.cnki.issn.1674-4152.001026 LI Y, ZHANGT F, JIANG H B, et al. Clinical observation of lung protective ventilation in elderly patients with laparoscopic colorectal cancer surgery[J]. Chinese Journal of General Practice, 2019, 17(10): 1673-1677. doi: 10.16766/j.cnki.issn.1674-4152.001026
[3]	吕江军, 俞丽君, 吕小玲. 单肺通气期间输注右美托咪定对胸腔镜下老年肺部手术患者氧合和呼吸力学的影响[J]. 中华全科医学, 2019, 17(9): 1524-1526, 1570. doi: 10.16766/j.cnki.issn.1674-4152.000987 LYU J J, YU L J, LYU X L. Effects of dexmedetomidine infusion during one-lung ventilation on oxygenation and respiratory mechanics in elderly patients undergoing thoracoscopic lung surgery[J]. Chinese Journal of General Practice, 2019, 17(9): 1524-1526, 1570. doi: 10.16766/j.cnki.issn.1674-4152.000987
[4]	LIU H, CAO Y Y, ZHANG L, et al. Pressure-controlled volume-guaranteed ventilation improves respiratory dynamics in pediatric patients during laparoscopic surgery: A prospective randomized controlled trial[J]. Int J Gen Med, 2021, 14: 2721-2728. doi: 10.2147/IJGM.S318008
[5]	白洁, 马磊, 孟丽华, 等. 压力控制容量保证通气模式对妇科腹腔镜手术患者呼吸力学的影响[J]. 国际麻醉学与复苏杂志, 2018, 39(10): 934-937. https://www.cnki.com.cn/Article/CJFDTOTAL-HNGY201705006.htm BAI J, MA L, MENG L H, et al. Effect of pressure-controlled ventilation-volume guaranteed mode on respiratory mechanics in gynecologic laparoscopic surgery[J]. International Journal of Anesthesiology and Resuscitation, 2018, 39(10): 934-937. https://www.cnki.com.cn/Article/CJFDTOTAL-HNGY201705006.htm
[6]	范薇, 孙勇, 李广明, 等. 压力控制容量保证通气模式改善创伤性脑损伤患者早期预后[J]. 临床麻醉学杂志, 2021, 37(5): 489-493. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202105011.htm FAN W, SUN Y, LI G M, et al. Pressure-controlled ventilation-volumeguaranteed improved early prognosis of patients undergoing traumatic brain injury[J]. Journal of Clinical Anesthesiology, 2021, 37(5): 489-493. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202105011.htm
[7]	秦海倩, 卢悦淳, 孙健, 等. PCV-VG对Trendelenburg体位腹腔镜手术老年患者的肺保护作用[J]. 中华麻醉学杂志, 2020, 40(2): 151-155. https://cdmd.cnki.com.cn/Article/CDMD-10062-1021565449.htm QIN H Q, LU Y C, SUN J, et al. Lung protection effect of PCV-VG on elderly patients undergoing laparoscopic surgery in Trendelenburg position[J]. Chinese Journal of Anesthesiology, 2020, 40(2): 151-155. https://cdmd.cnki.com.cn/Article/CDMD-10062-1021565449.htm
[8]	WANG P, ZHAO S H, GAO Z B, et al. Use of volume controlled vs. pressure controlled volume guaranteed ventilation in elderly patients undergoing laparoscopic surgery with laryngeal mask airway[J]. BMC Anesthesiol, 2021, 21(1): 69. doi: 10.1186/s12871-021-01292-y
[9]	LEE J M, LEE S K, RHIM C C, et al. Comparison of volume-controlled, pressure-controlled, and pressure-controlled volume-guaranteed ventilation during robot-assisted laparoscopic gynecologic surgery in the Trendelenburg position[J]. Int J Med Sci, 2020, 17(17): 2728-2734. doi: 10.7150/ijms.49253
[10]	宋雪松, 王昊, 康建勋. 压力控制容量保证通气模式对腹腔镜结肠癌根治术老年患者的影响[J]. 重庆医学, 2020, 49(11): 1774-1777, 1781. doi: 10.3969/j.issn.1671-8348.2020.11.013 SONG X S, WANG H, KANG J X. Effect of pressure-controlled volume-guaranteed ventilation pattern on elderly patients undergoing laparoscopic radical resection of colon cance[J]. Chongqing Medicine, 2020, 49(11): 1774-1777, 1781. doi: 10.3969/j.issn.1671-8348.2020.11.013
[11]	KOTHARI A, BASKARAN D. Pressure-controlled volume guaranteed mode improves respiratory dynamics during laparoscopic cholecystectomy: A comparison with conventional modes[J]. Anesth Essays Res, 2018, 12(1): 206-212. doi: 10.4103/aer.AER_96_17
[12]	左贞艳, 张洁, 陈泳伊, 等. 压力控制容量保证通气模式对肺切除术患者术后肺部并发症的影响[J]. 临床麻醉学杂志, 2021, 37(6): 569-573. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202106002.htm ZUO Z Y, ZHANG J, CHEN Y Y, et al. Effect of pressure control ventilation with volume guarantee mode on postoperative pulmonary complications in patients undergoing pulmonary resection[J]. Journal of Clinical Anesthesiology, 2021, 37(6): 569-573. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202106002.htm
[13]	郑剑桥, 冉佳豪, 孙小惠, 等. 压力控制容量保证模式用于术中单肺通气有效性和安全性的系统评价[J]. 四川医学, 2020, 41(7): 721-727. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX202007013.htm ZHENG J Q, RAN J H, SUN X H, et al. Systematic Evaluation of the Effectiveness and Safety of Intraoperative One-Lung Ventilation with Pressure Controlled Volume Guaranteed[J]. Sichuan Medical Journal, 2020, 41(7): 721-727. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX202007013.htm
[14]	王舜, 万海方, 倪燕华. 压力控制通气模式对老年脊柱结核患者术后谵妄的影响[J]. 中华全科医学, 2021, 19(6): 944-946, 968. doi: 10.16766/j.cnki.issn.1674-4152.001956 WANG S, WAN H F, NI Y Y H. Effect of pressure controlled ventilation on postoperative delirium in elderly patients with spinal tuberculosis[J]. Chinese Journal of General Practice, 2021, 19(6): 944-946, 968. doi: 10.16766/j.cnki.issn.1674-4152.001956
[15]	SCHICK V, DUSSE F, ECKARDT R, et al. Comparison of volume-guaranteed or -targeted, pressure-controlled ventilation with volume-controlled ventilation during elective surgery: A systematic review and meta-analysis[J]. J Clin Med, 2021, 10(6): 1276. doi: 10.3390/jcm10061276