俯卧位脊柱手术中容量控制通气与压力控制通气的比较：一项荟萃分析。

Volume-controlled ventilation versus pressure-controlled ventilation during spine surgery in the prone position: A meta-analysis.

作者信息

Han Jun, Hu Yunxiang, Liu Sanmao, Hu Zhenxin, Liu Wenzhong, Wang Hong

机构信息

Department of Spine Surgery, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian, 116033, Liaoning, China.

Department of Spine Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.

出版信息

Ann Med Surg (Lond). 2022 May 25;78:103878. doi: 10.1016/j.amsu.2022.103878. eCollection 2022 Jun.

BACKGROUND

Many studies have investigated a comparison of the potency and safety of PCV versus VCV modes in spinal surgery in prone position. However, controversy about the maximal benefits of which ventilation modes remains. The main purpose of this meta-analysis was to investigate which one is the optimal ventilation for surgery patients undergoing spine surgery in prone position between the two ventilation modes as PCV and VCV.

METHODS

We conducted a comprehensive search of PubMed, Embase, Web of Science, the Cochrane Library, and Google Scholar for potentially eligible articles. The continuous outcomes were analyzed using the mean difference and the associated 95% confidence interval. Meta-analysis was performed using Review Manager 5.4 software.

RESULTS

Our meta-analysis included 8 RCTs involving a total of 454 patients between 2012 and 2020. The results demonstrated that IOB, Ppeak and CVP for VCV are significantly superior to PCV in spinal surgery in prone position. And PCV had higher Cdyn and PaO/FiO than VCV. But there was no significant difference between PCV and VCV in terms of POB, Hb, HCT, HR and MAP.

CONCLUSIONS

The PCV mode displayed a more satisfying effect than VCV mode. Compared to VCV mode in same preset of tidal volume, the patients with PCV mode in prone position demonstrated less IOB, lower Ppeak and CVP, and higher PaO/FiO in spinal surgery. However, there is no obvious difference between PCV and VCV in terms of hemodynamics variables (HR and MAP).

背景

许多研究探讨了在俯卧位脊柱手术中压力控制通气（PCV）与容量控制通气（VCV）模式的效能和安全性比较。然而，关于哪种通气模式的最大益处仍存在争议。本荟萃分析的主要目的是研究在PCV和VCV这两种通气模式中，哪种是俯卧位脊柱手术患者的最佳通气方式。

方法

我们全面检索了PubMed、Embase、Web of Science、Cochrane图书馆和谷歌学术，以查找潜在符合条件的文章。使用平均差和相关的95%置信区间分析连续结局。使用Review Manager 5.4软件进行荟萃分析。

结果

我们的荟萃分析纳入了2012年至2020年间的8项随机对照试验，共454例患者。结果表明，在俯卧位脊柱手术中，VCV的吸气平台压（IOB）、气道峰压（Ppeak）和中心静脉压（CVP）显著优于PCV。且PCV的动态顺应性（Cdyn）和动脉血氧分压/吸入氧浓度（PaO/FiO）高于VCV。但在呼气末正压（POB）、血红蛋白（Hb）、血细胞比容（HCT）、心率（HR）和平均动脉压（MAP）方面，PCV和VCV之间无显著差异。