喉罩气道通气模式在妇科腹腔镜手术中对肺力学、血流动力学反应及血气分析的作用。

The role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis.

作者信息

Jarahzadeh Mohammad Hossein, Halvaei Iman, Rahimi-Bashar Farshid, Behdad Shekoufeh, Abbasizadeh Nasrabady Rouhollah, Yasaei Elahe

机构信息

Anesthesiology and Critical Care Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.

出版信息

Int J Reprod Biomed. 2016 Dec;14(12):755-760.

PMID:28066834

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5203690/

Abstract

BACKGROUND

There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV).

OBJECTIVE

To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway (LMA) at different time intervals.

MATERIALS AND METHODS

Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV (tidal volume: 10 ml/kg) and PCV. In the PCV group, ventilation was initiated with a peak airway pressure (tidal volume: 10 ml/kg, upper limit: 35 cm HO). In both groups, the arterial blood samples were taken in several time intervals (5, 10 and 15 min after LMA insertion) for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals.

RESULTS

There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO was significantly higher after 10 and 15 min in VCV group compared to PCV group (p=0.005 and p=0.03, respectively). PaCO showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO showed significant increase after 10 and 15 min in VCV compared to PCV group.

CONCLUSION

Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV.

摘要

背景

妇科腹腔镜手术中有两种通气方法：容量控制通气（VCV）和压力控制通气（PCV）。

目的

比较在不同时间间隔使用喉罩气道（LMA）时，VCV和PCV两种模式的肺力学、血流动力学反应、动脉血气分析及气体交换情况。

材料与方法

60例因诊断性腹腔镜检查而转诊的不孕妇女，根据通气模式随机分为VCV组（潮气量：10 ml/kg）和PCV组。PCV组以气道峰压（潮气量：10 ml/kg，上限：35 cm H₂O）开始通气。两组均在几个时间间隔（插入LMA后5、10和15分钟）采集动脉血样本进行血气评估。同时持续监测肺力学参数，并在不同时间间隔记录。

结果

两组患者的年龄、体重、身高和BMI无显著差异。插入LMA后5分钟和10分钟时，VCV组的气道峰压和平台压显著高于PCV组。与PCV组相比，VCV组在10分钟和15分钟后PaO₂显著更高（分别为p = 0.005和p = 0.03）。PCV组在5分钟后PaCO₂显著升高，但两组在10分钟和15分钟后差异不显著。与PCV组相比，VCV组在10分钟和15分钟后呼气末CO₂显著升高。