压力和容量控制通气对患儿呼吸力学的影响

发布时间：2018-09-03 09:13

【摘要】：目的采用自身对照的方法比较压力控制通气(PCV)和容量控制通气(VCV)对患儿术中呼吸力学及血流动力学的影响。方法全麻下择期手术患儿30例,年龄0~6个月,术前给予患儿右美托咪定负荷剂量0.1μg·kg-1·min-1,10 min内输注完毕。待患儿安静入睡,记录此时RR及呼气末二氧化碳(EtCO2)作为模拟生理睡眠状态下的RR及EtCO2。常规麻醉诱导后,顺序给予容量控制通气(VCV)及压力控制通气(PCV),以患儿模拟生理状态下的RR为基础,调节通气压力或VT,以维持术前基础EtCO2。连续监测患儿ECG、NIBP、SpO2、RR、EtCO2、BIS及气道峰压(Ppeak)、气道平均压(Pmean)、气道平台压(Pplat)、Vt、分钟通气量(MV)、肺顺应性(Compl)等呼吸力学参数。结果 PCV 15min时患儿Ppeak值(16.8±2.9)cm H2O明显低于VCV 15min时患儿的(18.3±3.3)cm H2O,而PCV 15 min时患儿Pmean值(7.0±1.8)cm H2O明显高于VCV 15min时患儿的(6.2±1.7)cm H2O(P0.05);患儿采用两种通气模式时Pplat、Vt、MV、Compl、BIS及血流动力学指标差异无统计学意义。结论两种通气模式都可安全有效地应用于新生儿和小婴儿术中机械通气,而PCV模式在预防患儿Ppeak过高、改善氧合方面更有优势。
[Abstract]:Objective to compare the effects of pressure controlled ventilation (PCV) and volume controlled ventilation (VCV) on respiratory mechanics and hemodynamics in children. Methods Thirty children (age 0 ~ 6 months) undergoing elective operation under general anesthesia were infused with dexmetomidine (0.1 渭 g kg-1 min-1,10 min) before operation. When the child falls asleep quietly, record RR and end-expiratory carbon dioxide (EtCO2) as RR and EtCO2. during physiological sleep. After induction of routine anesthesia, (VCV) and (PCV), were given volume controlled ventilation and pressure controlled ventilation, which were based on RR in simulated physiological state of children. Ventilation pressure or VT, were adjusted to maintain the basic EtCO2. before operation. Respiratory mechanics parameters such as ECG,NIBP,SpO2,RR,EtCO2,BIS and peak airway pressure (Ppeak), mean airway pressure (Pmean), airway plateau pressure (Pplat), minute ventilation volume (MV), pulmonary compliance (Compl) and so on were continuously monitored. Results the Ppeak value of PCV 15min group (16.8 卤2.9) cm H2O was significantly lower than that of VCV 15min group (18.3 卤3.3) cm H2O, while the Pmean value of PCV 15 min group was (7.0 卤1.8) cm H2O significantly higher than that of VCV 15min group (6.2 卤1.7) cm H2O (P0.05). Conclusion both of the two ventilation modes can be safely and effectively applied to neonates and small infants during intraoperative mechanical ventilation, while the PCV model has more advantages in preventing excessive Ppeak and improving oxygenation in infants.
【作者单位】：上海交通大学医学院附属上海儿童医学中心麻醉科;
【基金】：上海浦东新区科技发展基金创新资金项目(PKJ2013-Y61)
【分类号】：R726.1

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