Aydın Venera, Kabukcu Hanife Karakaya, Sahin Nursel, Mesci Ayhan, Arici Ayse Gulbin, Kahveci Gulsum, Ozmete Ozgen
Department of Anesthesiology and Reanimation, Akdeniz University, Antalya, Turkey.
Department General Surgeon, Akdeniz University, Antalya, Turkey.
Clin Respir J. 2016 May;10(3):342-9. doi: 10.1111/crj.12223. Epub 2014 Nov 14.
Laparoscopic cholecystectomy has many advantages such as shorter hospital stay of patients, minimal postoperative pain, rapid recovery after the operation; however, systemic disadvantages because intra-abdominal pressure, position and general anaesthesia may also appear. In this study, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) modes during laparoscopic cholecystectomy operations were compared in terms of their effects on haemodynamic, respiratory and blood gas parameters.
Patients were randomly assigned to two groups according to the modes of mechanical ventilation, either to the PCV group, group P (35 patients) or to the VCV group, group V (35 patients). A standard electrocardiogram, pulse oximetry, non-invasive blood pressure, end-tidal CO2 , BIS and TOF monitoring were performed. Anaesthesia was induced with propofol, fentanyl and rocuronium. Anaesthesia was maintained with 50% O2 + 50% N2 O, propofol infusion and fentanyl. Haemodynamic data, respiratory parameters, arterial blood gases of the patients were measured. Dynamic compliance of the respiratory system, oxygenation index, alveolar-arterial oxygen gradient and dead space ventilation to tidal volume ratio were calculated.
No difference was detected between the groups in terms of descriptive data, operation, anaesthesia, pneumoperitoneum and recovery period (P > 0.05). Haemodynamic data and blood gas values were compared between the two groups, and no significant difference was found (P < 0.05). After pneumoperitoneum, lung compliance decreased in both groups, more importantly in the Group P (P > 0.05). Tidal volume increased 10 min and 20 min after insufflation in the Group V (P < 0.05). Alveolar dead space ventilation to tidal volume ratio before pneumoperitoneum and alveolar-arterial oxygen gradient after pneumoperitoneum were significantly higher in the Group P compared to the Group V (P < 0.05). Dynamic compliance of the respiratory system was similar in both groups.
In this study, with volume-controlled ventilation anaesthesia in laparoscopic cholecystectomy, higher tidal volume and lower alveolar-arterial oxygen gradient were achieved after pneumoperitoneum. These findings indicated that VCV mode can provide a better alveolar ventilation than PCV mode in laparoscopic cholecystectomy operations.
腹腔镜胆囊切除术具有诸多优点，如患者住院时间短、术后疼痛轻微、术后恢复快；然而，由于腹内压、体位和全身麻醉等因素，也可能出现全身性劣势。在本研究中，比较了腹腔镜胆囊切除术期间压力控制通气（PCV）和容量控制通气（VCV）模式对血流动力学、呼吸和血气参数的影响。
根据机械通气模式将患者随机分为两组，即PCV组（P组，35例患者）和VCV组（V组，35例患者）。进行标准心电图、脉搏血氧饱和度、无创血压、呼气末二氧化碳、脑电双频指数（BIS）和四个成串刺激（TOF）监测。采用丙泊酚、芬太尼和罗库溴铵诱导麻醉。用50%氧气+50%氧化亚氮、丙泊酚输注和芬太尼维持麻醉。测量患者的血流动力学数据、呼吸参数、动脉血气。计算呼吸系统的动态顺应性、氧合指数、肺泡-动脉氧分压差和死腔通气与潮气量比值。
两组在描述性数据、手术、麻醉、气腹和恢复期方面均未检测到差异（P>0.05）。比较两组的血流动力学数据和血气值，未发现显著差异（P<0.05）。气腹后，两组肺顺应性均下降，更重要的是P组下降更明显（P>0.05）。V组在充气后10分钟和20分钟潮气量增加（P<0.05）。与V组相比，P组气腹前的肺泡死腔通气与潮气量比值和气腹后的肺泡-动脉氧分压差显著更高（P<0.05）。两组呼吸系统的动态顺应性相似。
在本研究中，腹腔镜胆囊切除术采用容量控制通气麻醉时，气腹后可实现更高的潮气量和更低的肺泡-动脉氧分压差。这些发现表明，在腹腔镜胆囊切除术操作中，VCV模式比PCV模式能提供更好的肺泡通气。
