压力控制通气和容量控制通气对后路腰椎椎体间植骨融合术患者围术期失血影响的比较

摘要

Objective To compare the effects of pressure controlled ventilation and volume controlled ventilation on perioperative blood loss of patients with posterior lumbar interbody fusion (PLIF).Methods According to the random number table method,a total of 88 patients scheduled to PLIF were allocated into two groups,44 cases per groups.Patients received respectively pressure controlled ventilation and volume controlled ventilation in pressure controlled ventilation group (PCV group) and volume controlled ventilation group (VCV group).Mean arterial blood pressure (MAP),heart rate (HR) and central venous pressure (CVP) were continuously monitored at anesthesia induction immediately (T0),10min after supine position to prone position (T1),skin suture immediately (T2),10min after prone position to supine position (T3) and when tracheal extubation (T4).Hemoglobin (Hb) and hematokrit (HCT) were tested from T0 to T4 in the two groups.Respiratory parameters were recorded from T0 to T3 in the two groups.Intraoperative blood loss and blood loss at 96h after operation patients were recorded.Allogeneic blood transfusion,volume of fluid input and the rate of secondary surgery to stop th bleeding were recorded in the two groups.Results Compared to VCV group,peak inspimtory pressure (PIP) from T1 to T3 were all significantly lower (P ＜0.05) in PCV group.There was no statistical significance (P ＞ 0.05) in MAP,HR,tidal volume,respiratory rate (RR),PaO2/FiO2 and PaCO2 between the two groups.There was no statistical significance (P ＞ 0.05) in Hb and Hct at different time points between the two groups.Compared to VCV group,intraoperative blood loss,plasma infusions and red blood cell infusions were al significantly lower (P ＜ 0.05) in PCV group.Conclusion PCV can decrease intraoperative blood loss of patients with PLIF,which may be related to lower PIP during operation.%目的 比较压力控制通气和容量控制通气对后路腰椎椎体间植骨融合术(PLIF)患者围术期失血的影响.方法 选取择期接受PLIF的患者共88例,采用数字表法随机分为两组,即压力控制通气组(PCV组,n=44)和容量控制通气组(VCV组,n =44),分别采用压力控制通气模式和容量控制通气模式进行机械通气.分别于麻醉诱导即刻(T0)、仰卧位改为俯卧位后10min (T1)、皮肤缝合即刻(T2)、俯卧位改为仰卧位后10min (T3)及气管导管拔管时(T4)连续监测平均动脉压(MAP)、心率(HR)及中心静脉压(CVP),并于上述时间点分别测定两组患者血红蛋白(Hb)及血细胞比容(Hct).记录T0～T3时的呼吸参数.记录两组患者的术中失血量、术后96h失血量.记录两组患者异体输血情况、补液量和二次手术止血率.结果 与VCV组比较,PCV组于T1～T3时的气道峰压(PIP)均明显降低(P＜0.05).VCV组和PCV组间不同时点的MAP、HR、潮气量、呼吸频率(RR)、PaO2/FiO2及PaCO2差异均无统计学意义(P＞0.05).两组间患者各时点Hb及Hct差异均无统计学意义(P＞0.05).与VCV组比较,PCV组术中失血量、血浆输注量及红细胞输注量均明显降低(P＜0.05).结论 术中给予PCV通气模式可降低接受PLIF术患者术中的失血量,其原因可能与术中更低的气道峰压有关.