Liu Huan, Cao Yuanyuan, Zhang Lei, Liu Xuesheng, Gu Erwei
Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
Int J Gen Med. 2021 Jun 22;14:2721-2728. doi: 10.2147/IJGM.S318008. eCollection 2021.
Pressure-controlled volume-guaranteed (PCV-VG) combines the characteristics of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV). It has been reported that PCV-VG decreases airway pressure and improves oxygenation among the adult group. In this study, the respiratory dynamics of PCV-VG and VCV are compared in pediatric patients ventilated with laryngeal mask airway and underwent laparoscopic hernia of the sac ligation.
Sixty-four pediatric patients were included in this prospective, randomized clinical trial. Pediatric patients were randomly allocated to receive VCV and PCV-VG ventilation during the general anesthesia. The hemodynamic and respiratory variables were recorded at the time when laryngeal mask airway was placed, pneumoperitoneum began, 5 mins after pneumoperitoneum began, pneumoperitoneum ended, and the operation ended respectively. The respiratory adverse events were recorded after the operation and on the first day after the operation. In this study, respiratory adverse events are defined as cough, hoarseness, hypoxemia, laryngospasm, bronchospasm, and sore throat.
There was no statistical difference in hemodynamic variables at all time points between the two groups. Compared to the VCV group, peak airway pressure (Ppeak) and plateau airway pressure in the PCV-VG group decreased significantly. Pulmonary dynamic compliance (Cydn) in the PCV-VG group was significantly higher than that in the VCV group. The respiratory adverse events appeared to have no statistical difference between VCV and PCV groups.
PCV-VG provides a lower Ppeak and better Cydn in pediatric patients compared with the VCV group during laparoscopic surgery. The results suggested that PCV-VG may be a superior way of mechanical ventilation for pediatric patients who ventilated with laryngeal mask airway and experienced laparoscopic surgery.
压力控制容量保证通气（PCV-VG）结合了压力控制通气（PCV）和容量控制通气（VCV）的特点。据报道，PCV-VG可降低成年人群的气道压力并改善氧合。在本研究中，对使用喉罩气道通气并接受腹腔镜疝囊结扎术的儿科患者的PCV-VG和VCV的呼吸动力学进行了比较。
本前瞻性随机临床试验纳入了64例儿科患者。儿科患者在全身麻醉期间被随机分配接受VCV和PCV-VG通气。分别在放置喉罩气道时、气腹开始时、气腹开始5分钟后、气腹结束时和手术结束时记录血流动力学和呼吸变量。术后及术后第一天记录呼吸不良事件。在本研究中，呼吸不良事件定义为咳嗽、声音嘶哑、低氧血症、喉痉挛、支气管痉挛和咽痛。
两组在所有时间点的血流动力学变量均无统计学差异。与VCV组相比，PCV-VG组的气道峰压（Ppeak）和气道平台压显著降低。PCV-VG组的肺动态顺应性（Cydn）显著高于VCV组。VCV组和PCV组之间的呼吸不良事件似乎无统计学差异。
在腹腔镜手术期间，与VCV组相比，PCV-VG在儿科患者中提供了更低的Ppeak和更好的Cydn。结果表明，PCV-VG可能是使用喉罩气道通气并接受腹腔镜手术的儿科患者机械通气的一种更好方式。
