婴儿Ambu喉罩通气下压力与容量控制通气的呼吸动力学比较

发布时间：2018-05-14 20:51

本文选题：婴儿 + 喉罩　；参考：《上海医学》2015年06期

【摘要】：目的采用连续气道监测手段,观察婴儿使用Ambu喉罩通气时,压力控制通气(PCV)与容量控制通气(VCV)的呼吸动力学指标差异。方法选择6~12月龄择期行尿道下裂手术的患儿40例,按随机数字表法分入PCV组和VCV组,每组20例,患儿在静脉麻醉诱导后,置入Ambu喉罩,分别行PCV和VCV。在通气期间维持患儿呼气末二氧化碳分压(petCO2)为30~40 mmHg(1 mmHg=0.133kPa)。记录喉罩置入时(T1)和置入后10min(T2)、20min(T3)、30min(T4)时的呼吸动力学和血流动力学指标。观察喉罩相关不良反应的发生情况。结果 VCV组在T4时间点的呼气阻力(RE)显著高于同组T1时间点(P0.05);在T3、T4时间点的气道峰压(PIP)值显著高于PCV组同时间点(P值均0.05),而呼气峰流速(PEF)值显著低于PCV组同时间点(P0.05)。两组在T1时间点的肺顺应性(Compl)值显著高于同组其他时间点(P0.05),呼吸功(WOB)显著高于同组T3、T4时间点(P值均0.05)。VCV组的漏气分数、吸入潮气量(VTin)、呼出潮气量(VTex)、PIP、吸气平台压(pplat)、呼气末正压(PEEP)、平均气道压(pmean)、petCO2、PEF和PCV组的漏气分数、VTin、VTex、PIP、pplat、PEEP、pmean、petCO2、PEF、RE虽随时间变化略有波动,但组内差异均无统计学意义(P值均0.05)。两组间各时间点的漏气分数、VTin、VTex、pplat、PEEP、pmean、petCO2、Compl、RE和WOB的差异均无统计学意义(P值均0.05)。结论 PCV和VCV均能安全地应用于使用Ambu喉罩通气的6~12月龄患儿。但随着手术时间的延长,行VCV患儿的PIP呈升高趋势,可能增加安全隐患,因此PCV可能更安全。
[Abstract]:Objective to observe the difference of respiratory dynamics between pressure controlled ventilation (Ambu) and volume controlled ventilation (VCV) when infants were ventilated with Ambu laryngeal mask by means of continuous airway monitoring. Methods Forty children with hypospadias undergoing hypospadias surgery at the age of 6 and 12 months were randomly divided into PCV group and VCV group with 20 cases in each group. After intravenous anesthesia induction, Ambu larynx mask was placed and PCV and VCV were performed respectively. The maintenance of end-expiratory partial pressure of carbon dioxide (pet CO _ 2) during ventilation was 30 ~ 40 mmHg(1 / h ~ (-1) and 0.133 KPA. Respiratory dynamics and hemodynamics were recorded at the time of laryngeal mask placement (T _ 1) and 10 min after implantation (T _ 2 / T _ (2) T _ (2) T _ (3) T _ (3) T _ (3) T _ (3) ~ (30 min) T _ (4). To observe the occurrence of laryngeal mask related adverse reactions. Results the expiratory resistance of VCV group at T4 time point was significantly higher than that of the same group at T1 time point (P0.05A), and the peak airway pressure peak pressure (PIP) value at T3 T4 time point was significantly higher than that of PCV group at the same time point (P < 0.05), while the peak expiratory flow velocity (PEFV) value was significantly lower than that in PCV group at the same time point (P0.05U). The complicity of lung at T1 time point in both groups was significantly higher than that in the other time points of the same group (P0.05A), and the respiratory work in both groups was significantly higher than that in 0.05).VCV group at T3T4 time point. In the PCV group, there were no significant differences in the mean airway pressure (P = 0.05) and the mean air leakage fraction (P < 0.05), although the volume of tidal volume in the PCV group was slightly different from that of the control group (P < 0.05), but there was no significant difference between the two groups in terms of the volume of tidal volume and the volume of tidal volume in the PCV group, although there was a slight change in the volume of tidal volume, the positive end-expiratory pressure (PEEPP) and the positive end-expiratory pressure (PEEP) were not significantly different between the two groups (P = 0.05), and the mean air leakage fraction (P) of the PCV group was higher than that of the control group (P = 0.05), but there was no significant difference between the two groups. There was no significant difference in RE and WOB between the two groups. Conclusion both PCV and VCV can be safely used in children with Ambu laryngeal mask ventilation. However, with the prolongation of operation time, the PIP of children with VCV showed an increasing trend, which may increase the hidden danger of safety, so PCV may be more safe.
【作者单位】：上海交通大学附属儿童医院麻醉科;上海交通大学附属第一人民医院麻醉科;
【分类号】：R726.1

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