不同通气模式对 Trendelenburg 体位腹腔镜手术患者 PaO 2和 PaCO 2的影响

摘要

目的：探讨压力控制通气(PCV)联合呼气末正压(PEEP)在 Trendelenburg 体位腹腔镜手术中对 PaO 2和 PaCO 2的影响。方法腹腔镜直肠癌根治术患者40例,年龄35~55岁,随机分为两组,每组20例。A 组采用容量控制通气模式(VCV)通气[VT =体重(kg)×10 ml]20 min 后,改用 PCV 模式通气20 min,返回 VCV 模式继续通气20 min 后,采用 PCV+低 PEEP(5 cm H 2 O)模式通气20 min。B 组则将 PCV 与 PCV+PEEP 的顺序调换。在切换通气模式时行动脉血气分析。结果两组 VCV 模式时 PaO 2均明显低于 PCV 模式及 PCV+PEEP 模式(P <0.05)。PCV 模式时PaO 2明显低于 PCV+ PEEP 模式(P <0.05)；VCV 模式时 PaCO 2明显高于 PCV 模式和 PCV+PEEP 模式(P <0.05),而 PCV 模式和 PCV+PEEP 模式时 PaCO 2差异无统计学意义。VCV 模式时动脉血 pH 值明显低于 PCV 和 PCV+PEEP 模式(P <0.05),PCV 和 PCV+PEEP 模式时动脉血pH 值差异无统计学意义。结论 Trendelenburg 体位腹腔镜手术时采用 PCV+PEEP 通气模式,与单纯 VCV 或单纯 PCV 模式比较,在提高 PaO 2以及降低 PaCO 2方面更具优势。%Objective To investigate the effects of different ventilation modes on PaCO 2 and PaO 2 during laparoscopic surgery in the Trendelenburg position.Methods Forty cases of laparoscopic resection of rectal cancer were randomly divided into group A (n =20)and group B (n =20).Under general anesthesia,all the cases were in volume-controlled ventilation mode (VCV,tidal volume=10 ml/kg)before pneumoperitoneum.After ventilating in VCV mode for 20 minutes with a lower tidal volume (8 ml/kg),group A was converted to PCV mode for 20 minutes and then back to the VCV mode for 20 minutes again.Next we switched to PCV combined with PEEP (5 cm H 2 O)mode (PCV+PEEP)for 20 minutes.In group B,we only alternated PCV with PCV combined with PEEP.Arte-rial blood-gas analysis was obtained at each time when ventilating mode changed.Results In both group A and B,PaO 2 in VCV mode was less than that in PCV mode and PCV+PEEP mode (P <0.05),PaO 2 in PCV mode was also less than that in mode PCV+PEEP mode (P <0.05).PaCO 2 in PCV and PCV combined with PEEP mode was less than that in VCV mode (P <0.05 ),and there was no difference of PaCO 2 in PCV mode and PCV+PEEP mode.The pH value in VCV mode was less than that in PCV mode and PCV+PEEP mode (P < 0.05).There was no difference in pH value between PCV mode and PCV+PEEP mode.Conclusion PCV combined PEEP mode is beneficial ei-ther in increasing or decreasing of PaCO 2 during laparoscopic surgery in the Trendelenburg position comparing with single VCV mode or PCV mode.