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腹腔镜手术中压力控制通气与容量控制通气:一项叙述性综述

Pressure Control Ventilation Versus Volume Control Ventilation in Laparoscopic Surgery: A Narrative Review.

作者信息

Sawant Urvi, Sen Jayshree, Madavi Sheetal

机构信息

Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

出版信息

Cureus. 2024 Aug 15;16(8):e66916. doi: 10.7759/cureus.66916. eCollection 2024 Aug.

DOI:10.7759/cureus.66916
PMID:39280384
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11401635/
Abstract

This review compares the safety and effectiveness of volume control ventilation (VCV) and pressure control ventilation (PCV) during laparoscopic surgery. Nine studies were chosen for in-depth examination following the application of stringent inclusion and exclusion criteria to the 184 publications that the literature search turned up. PCV is well-known for its capacity to preserve lower peak airway pressures during laparoscopic procedures, lowering the risk of volutrauma and barotrauma and enhancing oxygenation under these conditions of elevated intra-abdominal pressures. On the other hand, VCV guarantees a constant tidal volume and offers accurate ventilation management, both of which are essential for preserving stable carbon dioxide levels. VCV, however, may result in higher peak airway pressures, raising the risk of lung damage brought on by a ventilator. Research indicates that PCV provides better respiratory mechanics management during laparoscopic surgery, but VCV consistent tidal volume delivery is useful in some clinical situations. When choosing between PCV and VCV, the anesthesia team's experience, the demands of each patient, and the surgical circumstances should all be taken into consideration. Real-time monitoring tools and sophisticated ventilatory technology are essential for maximizing ventilation techniques. Further improving patient outcomes can be achieved by incorporating multimodal anesthesia approaches, such as the use of muscle relaxants and customized intraoperative fluid management. Muscle relaxants optimize conditions for mechanical ventilation by ensuring adequate muscle relaxation, reducing the risk of ventilator-associated lung injury, and enabling more precise control of ventilation parameters. Tailored intraoperative fluid management helps maintain optimal lung mechanics by avoiding fluid overload, which can lead to pulmonary edema and compromised gas exchange, necessitating adjustments in ventilation strategy. While both ventilation modalities can be utilized efficiently, the research suggests that PCV may be more advantageous in controlling oxygenation and airway pressures. In the dynamic and demanding world of laparoscopic surgery, ongoing research and clinical innovation are crucial to improving these tactics and guaranteeing the best possible treatment. In order to obtain the best possible patient outcomes during laparoscopic surgeries, this review emphasizes the significance of customized breathing techniques.

摘要

本综述比较了腹腔镜手术中容量控制通气(VCV)和压力控制通气(PCV)的安全性和有效性。在对文献检索找到的184篇出版物应用严格的纳入和排除标准后,选择了9项研究进行深入审查。PCV因其在腹腔镜手术过程中保持较低气道峰压的能力而闻名,可降低容积伤和气压伤的风险,并在腹内压升高的情况下改善氧合。另一方面,VCV可确保潮气量恒定并提供精确的通气管理,这两者对于维持稳定的二氧化碳水平至关重要。然而,VCV可能会导致更高的气道峰压,增加呼吸机引起肺损伤的风险。研究表明,PCV在腹腔镜手术期间能提供更好的呼吸力学管理,但VCV持续输送恒定潮气量在某些临床情况下很有用。在PCV和VCV之间进行选择时,应考虑麻醉团队的经验、每个患者的需求和手术情况。实时监测工具和先进的通气技术对于优化通气技术至关重要。通过采用多模式麻醉方法,如使用肌肉松弛剂和定制的术中液体管理,可以进一步改善患者预后。肌肉松弛剂通过确保足够的肌肉松弛来优化机械通气条件,降低呼吸机相关性肺损伤的风险,并使通气参数的控制更加精确。定制的术中液体管理有助于维持最佳肺力学,避免液体过载,因为液体过载可导致肺水肿和气体交换受损,从而需要调整通气策略。虽然两种通气方式都可以有效利用,但研究表明PCV在控制氧合和气道压力方面可能更具优势。在腹腔镜手术这个动态且要求高的领域,持续的研究和临床创新对于改进这些策略和确保最佳治疗效果至关重要。为了在腹腔镜手术中获得最佳患者预后,本综述强调了定制呼吸技术的重要性。

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Cureus. 2024 Aug 15;16(8):e66916. doi: 10.7759/cureus.66916. eCollection 2024 Aug.
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本文引用的文献

1
Advancing laparoscopy in resource-limited settings.在资源有限的情况下推进腹腔镜技术。
BMC Surg. 2024 Mar 26;24(1):98. doi: 10.1186/s12893-024-02387-2.
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Comparison of volume-controlled ventilation, pressure-controlled ventilation and pressure-controlled ventilation-volume guaranteed in infants and young children in the prone position: A prospective randomized study.仰卧位婴儿和幼儿容量控制通气、压力控制通气和压力控制通气-容量保证的比较:一项前瞻性随机研究。
J Clin Anesth. 2024 Aug;95:111440. doi: 10.1016/j.jclinane.2024.111440. Epub 2024 Mar 8.
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Pressure- vs. volume-controlled ventilation and their respective impact on dynamic parameters of fluid responsiveness: a cross-over animal study.压力控制通气与容量控制通气及其对液体反应性动态参数的影响:一项交叉动物研究。
BMC Anesthesiol. 2023 Sep 19;23(1):320. doi: 10.1186/s12871-023-02273-z.
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Automated control for investigation of the insufflation-ventilation interaction in experimental laparoscopy.自动化控制技术在实验性腹腔镜中对注气-通气相互作用的研究
PLoS One. 2023 May 5;18(5):e0285108. doi: 10.1371/journal.pone.0285108. eCollection 2023.
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Comparison between pressure-controlled ventilation with volume-guaranteed mode and volume-controlled mode in one-lung ventilation in infants undergoing video-assisted thoracoscopic surgery.在接受电视辅助胸腔镜手术的婴儿单肺通气中,压力控制通气联合容量保证模式与容量控制模式的比较。
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Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position.压力控制通气-容量保证模式联合个体化呼气末正压对腹腔镜手术中头高脚低位患者呼吸力学、氧合和肺损伤的影响。
J Clin Monit Comput. 2022 Aug;36(4):1155-1164. doi: 10.1007/s10877-021-00750-9. Epub 2021 Aug 26.
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Use of volume controlled vs. pressure controlled volume guaranteed ventilation in elderly patients undergoing laparoscopic surgery with laryngeal mask airway.老年患者喉罩通气下腹腔镜手术中容量控制通气与压力控制容量保证通气的应用。
BMC Anesthesiol. 2021 Mar 8;21(1):69. doi: 10.1186/s12871-021-01292-y.
8
Volume-Controlled Versus Dual-Controlled Ventilation during Robot-Assisted Laparoscopic Prostatectomy with Steep Trendelenburg Position: A Randomized-Controlled Trial.机器人辅助腹腔镜前列腺切除术采用大角度头低脚高位时容量控制通气与双控制通气的比较:一项随机对照试验
J Clin Med. 2019 Nov 21;8(12):2032. doi: 10.3390/jcm8122032.
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Respiratory mechanics during general anaesthesia.全身麻醉期间的呼吸力学
Ann Transl Med. 2018 Oct;6(19):379. doi: 10.21037/atm.2018.09.50.
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Pressure-controlled Volume Guaranteed Mode Improves Respiratory Dynamics during Laparoscopic Cholecystectomy: A Comparison with Conventional Modes.压力控制容量保证模式改善腹腔镜胆囊切除术期间的呼吸动力学:与传统模式的比较
Anesth Essays Res. 2018 Jan-Mar;12(1):206-212. doi: 10.4103/aer.AER_96_17.