Kothari Apoorwa, Baskaran Deepa
Department of Anaesthesia and Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
Anesth Essays Res. 2018 Jan-Mar;12(1):206-212. doi: 10.4103/aer.AER_96_17.
Pneumoperitoneum and altered positioning 1in laparoscopic cholecystectomy predispose to alterations in cardiorespiratory physiology. We compared the effects of volume controlled, pressure controlled, and the newly introduced pressure controlled-volume guaranteed ventilation (PCV-VG) modes of ventilation on respiratory mechanics and oxygenation during laparoscopic cholecystectomy.
Seventy-five physical status American Society of Anesthesiologists Classes I and II patients with normal lungs undergoing laparoscopic cholecystectomy were randomly allocated to receive volume controlled ventilation (VCV), pressure-controlled ventilation (PCV), or PCV-VG modes of ventilation during general anesthesia. In all modes of ventilation, the tidal volume was set at 8 mL/kg, and respiratory rate was set at 12 breaths/min with inspired oxygen of 0.4. After pneumoperitoneum, respiratory rate was adjusted to maintain an end-tidal carbon dioxide between 32 and 37 mm Hg. The peak airway pressures, compliance, the mean airway pressures, oxygen saturation, end tidal carbon dioxide and hemodynamics were recorded at the time of intubation (T1), 15 min after pneumoperitoneum (T2) and after desufflation (T3) and were compared. Arterial oxygen tension, arterial carbon dioxide tension at T2 and T3 were compared.
PCV-VG and PCV mode resulted in lower peak airway pressures than VCV (23.04 ± 3.43, 24.52 ± 2.79, and 27.24 ± 2.37 cm of water, respectively, = 0.001). Compliance was better preserved in the pressure mediated modes than VCV (fall from baseline was 42%, 29%, and 30% in VCV, PCV, and PCV-VG). The arterial to end-tidal carbon dioxide gradient was lower in PCV-VG and PCV compared to VCV. No difference in oxygenation and hemodynamics were observed.
PCV and PCV-VG modes are superior to VCV mode in providing adequate oxygenation at lower peak inspiratory pressures.
腹腔镜胆囊切除术中的气腹和体位改变易导致心肺生理功能改变。我们比较了容量控制通气、压力控制通气以及新引入的压力控制容量保证通气（PCV-VG）模式在腹腔镜胆囊切除术中对呼吸力学和氧合的影响。
75例美国麻醉医师协会身体状况分级为I级和II级、肺部正常且接受腹腔镜胆囊切除术的患者，在全身麻醉期间被随机分配接受容量控制通气（VCV）、压力控制通气（PCV）或PCV-VG通气模式。在所有通气模式中，潮气量设定为8 mL/kg，呼吸频率设定为12次/分钟，吸入氧浓度为0.4。气腹后，调整呼吸频率以维持呼气末二氧化碳分压在32至37 mmHg之间。记录插管时（T1）、气腹后15分钟（T2）和放气后（T3）的气道峰值压力、顺应性、平均气道压力、氧饱和度、呼气末二氧化碳分压和血流动力学参数，并进行比较。比较T2和T3时的动脉血氧分压、动脉血二氧化碳分压。
PCV-VG和PCV模式导致的气道峰值压力低于VCV（分别为23.04±3.43、24.52±2.79和27.24±2.37 cm水柱，P = 0.001）。压力介导模式下的顺应性比VCV更好地得以维持（VCV、PCV和PCV-VG相对于基线的下降分别为42%、29%和30%）。与VCV相比，PCV-VG和PCV模式下动脉血与呼气末二氧化碳分压差更低。未观察到氧合和血流动力学方面的差异。
在较低的吸气峰值压力下提供充足氧合方面，PCV和PCV-VG模式优于VCV模式。
