Moningi Srilata, Elmati Praveen Kumar, Rao Prasad, Kanithi Geetha, Kulkarni Dilip Kumar, Ramachandran Gopinath
Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Indian J Anaesth. 2017 Oct;61(10):818-825. doi: 10.4103/ija.IJA_605_16.
Pressure control and volume control ventilation are the most preferred modes of ventilator techniques available in the intraoperative period. The study compared the intraoperative ventilator and blood gas variables of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in patients undergoing single level anterior cervical discectomy and fusion (ACDF).
After obtaining Institutional Ethical Committee approval and informed consent, sixty patients scheduled for single level ACDF surgery performed in supine position under general anaesthesia were included. Group V (30 patients) received VCV and Group P (30 patients) received PCV. The primary objective was oxygenation variable PaO/FiO at different points of time i.e. T1-20 min after the institution of the ventilation, T2-20 min after placement of the retractors and T3-20 min after removal of the retractors. The secondary objectives include other arterial blood gas parameters, respiratory and haemodynamic parameters. NCSS version 9 statistical software was used for statistics. Two-way repeated measures for analysis of variance with Tukey Kramer test was used to analyse continuous variables for both intra- and inter-group comparisons, paired sample -test for overall comparison and Chi-square test for categorical data.
The primary variable PaO/FiO was comparable in both groups ( = 0.08). The respiratory variables, PAP and C were statistically significant in PCV group compared to VCV ( < 0.05), though clinically insignificant. Other secondary variables were comparable. ( > 0.05).
Clinically, both PCV and VCV group appear to be-equally suited ventilator techniques for anterior cervical spine surgery patients.
压力控制通气和容量控制通气是术中最常用的通气技术模式。本研究比较了接受单节段颈椎前路椎间盘切除融合术(ACDF)患者的容量控制通气(VCV)和压力控制通气(PCV)的术中通气及血气变量。
获得机构伦理委员会批准并取得知情同意后,纳入60例计划在全身麻醉下仰卧位进行单节段ACDF手术的患者。V组(30例患者)接受VCV,P组(30例患者)接受PCV。主要目标是不同时间点的氧合变量PaO/FiO,即通气开始后20分钟(T1)、放置牵开器后20分钟(T2)和移除牵开器后20分钟(T3)。次要目标包括其他动脉血气参数、呼吸和血流动力学参数。使用NCSS 9版统计软件进行统计分析。采用双向重复测量方差分析和Tukey Kramer检验分析组内和组间的连续变量,配对样本t检验进行总体比较,卡方检验分析分类数据。
两组的主要变量PaO/FiO相当(P = 0.08)。与VCV组相比,PCV组的呼吸变量、肺动脉压(PAP)和中心静脉压(CVP)有统计学意义(P < 0.05),但临床意义不显著。其他次要变量相当(P > 0.05)。
临床上,PCV组和VCV组似乎同样适用于颈椎前路手术患者的通气技术。