Department of Anesthesiology and Pain Medicine, Guri Hospital, Hanyang University Collge of Medicine, Guri, Korea.
Korean J Anesthesiol. 2011 Mar;60(3):167-72. doi: 10.4097/kjae.2011.60.3.167. Epub 2011 Mar 30.
Several publications have reported the successful, safe use of Laryngeal Mask Airway (LMA)-Classic devices in patients undergoing laparoscopic surgery. However, there have been no studies that have examined the application of volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) using a LMA during gynecological laparoscopy. The aim of this study is to compare how the VCV and PCV modes and using a LMA affect the pulmonary mechanics, the gas exchange and the cardiovascular responses in patients who are undergoing gynecological laparoscopy.
Sixty female patients were randomly allocated to one of two groups, (the VCV or PCV groups). In the VCV group, baseline ventilation of the lung was performed with volume-controlled ventilation and a tidal volume of 10 ml/kg ideal body weight (IBW). In the PCV group, baseline ventilation of the lung using pressure-controlled ventilation was initiated with a peak airway pressure that provided a tidal volume of 10 ml/kg IBW and an upper limit of 35 cmH(2)O. The end-tidal CO(2), the peak airway pressures (P(peak)), the compliance, the airway resistance and the arterial oxygen saturation were recorded at T1: 5 minutes after insertion of the laryngeal airway, and at T2 and T3: 5 and 15 minutes, respectively, after CO(2) insufflation.
The P(peak) at 5 minutes and 15 minutes after CO(2) insufflation were significantly increased compared to the baseline values in both groups. Also, at 5 minutes and 15 minutes after CO(2) insufflation, there were significant differences of the P(peak) between the two groups. The compliance decreased in both groups after creating the pneumopertoneim (P < 0.05).
Our results demonstrate that PCV may be an effective method of ventilation during gynecological laparoscopy, and it ensures oxygenation while minimizing the increases of the peak airway pressure after CO(2) insufflation.
已有多篇文献报道了在腹腔镜手术中使用喉罩气道（LMA）-Classic 装置的成功和安全性。然而，目前还没有研究检查使用 LMA 进行妇科腹腔镜手术时的容量控制通气（VCV）或压力控制通气（PCV）的应用。本研究旨在比较 VCV 和 PCV 模式以及使用 LMA 对行妇科腹腔镜手术患者的肺力学、气体交换和心血管反应的影响。
将 60 名女性患者随机分配至两组之一（VCV 或 PCV 组）。在 VCV 组中，通过容量控制通气以 10ml/kg 理想体重（IBW）的潮气量进行肺的基础通气。在 PCV 组中，使用压力控制通气以提供 10ml/kg IBW 潮气量和 35cmH₂O 上限的峰气道压开始肺的基础通气。记录呼气末 CO₂、峰气道压（Ppeak）、顺应性、气道阻力和动脉血氧饱和度在 T1（喉罩插入后 5 分钟），T2 和 T3（分别为 CO₂充气后 5 分钟和 15 分钟）时的值。
两组患者在 CO₂充气后 5 分钟和 15 分钟时的 Ppeak 与基础值相比均显著增加。而且，CO₂充气后 5 分钟和 15 分钟时，两组之间的 Ppeak 有显著差异。两组患者在建立气腹后顺应性均降低（P<0.05）。
我们的结果表明，PCV 可能是妇科腹腔镜手术中一种有效的通气方法，它可以确保氧合，同时最大限度地减少 CO₂充气后峰气道压的升高。
