摘要
目的比较不同机械通气模式对合并轻中度慢性阻塞性肺疾病(COPD)老年患者腹腔镜下胆囊切除术后肺氧合功能的影响。方法选择择期全身麻醉下行腹腔镜下胆囊切除术的合并轻中度COPD的90例老年患者,将其随机分成容量控制通气(VCV)组、压力控制通气(PCV)组和压力控制容量保证通气(PCV-VG)组,每组30例。3组患者术中采用相应的机械通气模式进行呼吸调控。比较3组患者的术中输液量、术中尿量、术中出血量、机械通气时间及拔除气管导管时间;记录3组患者麻醉前(T_(0))、拔除气管导管后30 min(T_(1))、术后第1天(T_(2))、术后第2天(T_(3))的心率、平均动脉压(MAP)、氧合指数及PaCO_(2)。结果3组患者的机械通气时间、术中输液量、术中出血量及术中尿量比较,差异均无统计学意义(均P>0.05);PCV组和PCV-VG组的拔除气管导管时间均短于VCV组(均P<0.05),而PCV组与PCV-VG组的拔除气管导管时间差异无统计学意义(P>0.05)。3组患者的MAP、心率、氧合指数及PaCO_(2)比较,差异均无统计学意义(均P>0.05);3组患者的MAP、心率及氧合指数均有随时间变化的趋势(均P<0.05),PaCO_(2)无随时间变化的趋势(P>0.05),其中3组患者T_(1)时的MAP和心率均高于T_(0)时,VCV组患者T_(1)、T_(2)时的氧合指数均低于T_(0)时,而PCV组和PCV-VG组患者T_(1)时的氧合指数均低于T_(0)时(均P<0.05);3组患者的MAP、心率及PaCO_(2)的分组与时间均无交互效应(均P>0.05),氧合指数的分组与时间有交互效应(P<0.05)。结论术中采用PCV模式或PCV-VG模式进行机械通气有利于合并轻中度COPD老年患者腹腔镜下胆囊切除术后肺氧合功能的恢复。
Objective To compare the effects of different mechanical ventilation modes on pulmonary oxygenation function after laparoscopic cholecystectomy in elderly patients complicated with mild to moderate chronic obstructive pulmonary disease(COPD).Methods Ninety elderly patients complicated with mild to moderate COPD undergoing elective laparoscopic cholecystectomy under general anesthesia were selected and randomly divided into volume-controlled ventilation(VCV)group,pressure-controlled ventilation(PCV)group and pressure-controlled ventilation with volume guaranteed(PCV-VG)group,with 30 cases in each group.The corresponding mechanical ventilation modes were intraoperatively used in the three groups for the ventilation management.The intraoperative infusion volume,intraoperative urine volume,intraoperative bleeding volume,mechanical ventilation duration,and duration for endotracheal extubation were compared among the three groups;heart rate,mean arterial pressure(MAP),oxygenation index,and PaCO_(2) before anesthesia(T_(0)),30 minutes after endotracheal extubation(T_(1)),on day 1 postoperatively(T_(2))and day 2 postoperatively(T_(3))were recorded in the three groups.Results There was no statistically significant difference in the mechanical ventilation duration,intraoperative infusion volume,intraoperative bleeding volume,or intraoperative urine volume among the three groups(all P>0.05).The PCV and PCV-VG groups had shorter duration for endotracheal extubation than the VCV group(all P<0.05),whereas there was no statistically significant difference in the duration for endotracheal extubation between the PCV group and the PCV-VG group(P>0.05).No statistically significant difference was found in the MAP,heart rate,oxygenation index,or PaCO_(2) among the three groups(all P>0.05);among the three groups,MAP,heart rate,and oxygenation index tended to change with time(all P<0.05),PaCO_(2) did not tend to change with time(P>0.05);MAP and heart rates of patients in the three groups at T_(1) were higher than those at T_(0),oxygenation indexes of patients in the VCV group at T_(1) and T_(2) were lower than that at T_(0),whereas oxygenation indexes of patients in the PCV and PCV-VG groups at T_(1) were lower than that at T_(0)(all P<0.05).Among the three groups,MAP,heart rate,or PaCO_(2) showed no interaction between grouping and time(all P<0.05),while the oxygenation index showed an interactive effect between grouping and time(P<0.05).Conclusion The intraoperative application of PCV mode or PCV-VG mode in mechanical ventilation is conducive to the recovery of pulmonary oxygenation function in elderly patients complicated with mild to moderate COPD after laparoscopic cholecystectomy.
作者
吴江东
杜学柯
陈丽妮
冼海燕
赵秀霞
WU Jiang-dong;DU Xue-ke;CHEN Li-ni;XIAN Hai-yan;ZHAO Xiu-xia(Department of Anesthesiology,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China)
出处
《广西医学》
CAS
2022年第7期717-721,共5页
Guangxi Medical Journal
基金
广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20181015)。
关键词
机械通气
腹腔镜下胆囊切除术
轻中度慢性阻塞性肺疾病
老年患者
氧合功能
Mechanical ventilation
Laparoscopic cholecystectomy
Mild to moderate chronic obstructive pulmonary disease
Elderly patient
Oxygenation function
