腹腔镜术中PRVC呼吸模式的应用研究

发布时间：2018-05-10 14:13

本文选题：压力调节容量控制通气 + 腹腔镜　；参考：《实用医学杂志》2017年03期

【摘要】：目的:通过在气腹过程中对PC、VC和PRVC 3种呼吸模式进行呼吸力学的监测并、对比、研究,来探讨PRVC呼吸模式临床使用的意义及价值。方法:腹腔镜胆囊切除术患者90例,随机分为压力控制、容量控制、压力调节容量控制通气3组,每组30例。分别在患者气腹前、气腹后5、10、15、20 min等5个时项段记录:食管压力、气道平均压、气道压峰值、动脉二氧化碳分压、呼气末CO_2浓度或分压、潮气量、平均动脉压、心率。结果:VC模式的PES在气腹后明显高于PC和PRVC模式。PC和VC模式气腹后10 min开始PaCO_2和ETCO_2明显升高(P0.05);PC不仅会使PaCO_2和ETCO_2升高,而且气腹后TV明显低于其他两组(P0.05)。PC和VC组气腹后通过使PaCO_2和ETCO_2上升,使MAP、HR显著升高(P0.05)。气腹后PRVC组MAP、HR显著低于PC、VC组(P0.05)。结论:PRVC模式可有效降低气腹引起的PAWM、PAP、PES升高,避免PaCO_2和ETCO_2在手术期的异常升高,保证围手术期患者的生命体征平稳。
[Abstract]:Objective: to monitor the respiratory mechanics of the 3 breathing patterns of PC, VC and PRVC during the pneumoperitoneum, compare and study the significance and value of the clinical use of PRVC breathing patterns. Methods: 90 cases of laparoscopic cholecystectomy were randomly divided into 3 groups of pressure control, volume control, and pressure regulating capacity control ventilation, 30 cases in each group. Before pneumoperitoneum, 5 time items such as 5,10,15,20 min after pneumoperitoneum were recorded: esophageal pressure, airway mean pressure, airway pressure peak, arterial carbon dioxide pressure, end expiratory CO_2 concentration or partial pressure, tidal volume, mean arterial pressure, heart rate. Results: VC mode PES was significantly higher than PC and PRVC mode.PC and VC mode pneumoperitoneum after pneumoperitoneum, and 10 min began PaCO_2. And ETCO_2 significantly increased (P0.05); PC not only makes PaCO_2 and ETCO_2 increase, but TV is significantly lower after pneumoperitoneum than the other two groups (P0.05).PC and VC group. PES increased to avoid abnormal elevation of PaCO_2 and ETCO_2 during operation, and to ensure stable vital signs during perioperative period.

【作者单位】：内蒙古大学生命科学院;内蒙古包钢医院;
【基金】：国家自然科学基金资助项目(编号:81560251)
【分类号】：R657.4

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