Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea.
J Clin Anesth. 2011 May;23(3):183-8. doi: 10.1016/j.jclinane.2010.08.006. Epub 2011 Mar 4.
To compare the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) on respiratory mechanics and hemodynamics in steep Trendelenburg position.
Prospective, randomized clinical trial.
University hospital.
34 ASA physical status 1 and 2 patients undergoing RLRP.
Patients were randomly allocated to either the VCV (n = 17) or the PCV group (n = 17). After induction of anesthesia, each patient's lungs were ventilated in constant-flow VCV mode with 50% O(2) and tidal volume of 8 mL/kg; a pulmonary artery catheter was then inserted. After establishment of 30° Trendelenburg position and pneumoperitoneum, VCV mode was switched to PCV mode in the PCV group.
Respiratory and hemodynamic variables were measured at baseline supine position (T1), post-Trendelenburg and pneumoperitoneum 60 minutes (T2) and 120 minutes (T3), and return to baseline after skin closure (T4).
The PCV group had lower peak airway pressure (AP(peak)) and greater dynamic compliance (C(dyn)) than the VCV group at T2 and T3 (P < 0.05). However, no other variables differed between the groups. Pulmonary arterial pressure and central venous pressure increased at T2 and T3 (P < 0.05). Cardiac output and right ventricular ejection fraction were unchanged in both groups.
PCV offered greater C(dyn) and lower AP(peak) than VCV, but no advantages over VCV in respiratory mechanics or hemodynamics.
比较容量控制通气（VCV）和压力控制通气（PCV）在头高脚低位对呼吸力学和血液动力学的影响。
前瞻性、随机临床试验。
大学医院。
34 例 ASA 身体状况 1 级和 2 级接受 RLRP 的患者。
患者被随机分配到 VCV 组（n = 17）或 PCV 组（n = 17）。麻醉诱导后，每位患者的肺在恒流 VCV 模式下以 50%O(2)和 8 mL/kg 的潮气量通气；然后插入肺动脉导管。建立 30°头高脚低位和气腹后，PCV 组将 VCV 模式切换为 PCV 模式。
在仰卧位基础（T1）、头高脚低位和气腹后 60 分钟（T2）和 120 分钟（T3）以及皮肤闭合后返回基础（T4）时测量呼吸和血液动力学变量。
与 VCV 组相比，PCV 组在 T2 和 T3 时气道峰压（AP(peak)）较低，动态顺应性（C(dyn))较大（P < 0.05）。然而，两组之间没有其他变量不同。肺动脉压和中心静脉压在 T2 和 T3 时升高（P < 0.05）。两组心输出量和右心室射血分数均无变化。
PCV 比 VCV 提供更大的 C(dyn)和更低的 AP(peak)，但在呼吸力学或血液动力学方面没有优于 VCV 的优势。
