摘要
目的 比较Wilson框架固定的俯卧位脊柱手术患者压力控制通气和容量控制通气的效果.方法 择期全麻下行脊柱手术并需使用Wilson框架固定的患者40例,ASA分级Ⅰ或Ⅱ级,年龄30 ～ 64岁,BMI＜ 30 kg/m2,采用随机数字表法,将其分为2组（n=20）：压力控制通气组（PCV组）和容量控制通气组（VCV组）.麻醉诱导后气管插管行机械通气,按理想体重,VCV组设定潮气量10ml/kg,PCV组调节麻醉机最大吸气压力,设定潮气量10 ml/kg.维持呼气末二氧化碳分压在正常范围内.于气管插管后仰卧位10 min、俯卧位30 min时,记录VT、RR、分钟通气量（MV）、肺顺应性（Cdyn）、气道峰压（Ppeak）、气道平均压（Pmean）、MAP和HR.并采集动脉血样,进行血气分析,计算氧合指数（OI）、生理死腔量/潮气量比率（VD/VT）.结果 与仰卧位10 min时比较,2组俯卧位30 min时Ppeak升高,Cdyn、VT及MV降低（P＜0.05）.与VCV组比较,PCV组Ppeak降低,RR、Cydn升高（P＜0.05）,VT、MV、OI、VD/VT和Pmean、MAP和HR差异无统计学意义（P＞0.05）.结论 与容量控制通气比较,压力控制通气可改善Wilson框架固定的俯卧位脊柱手术患者通气效果,减轻俯卧位对呼吸动力学的影响.
Objective To compare the pressure-controlled ventilation （PCV） and volume-controlled ventilation （VCV） in the patients undergoing spinal surgery in prone position supported by a Wilson frame.Methods Forty patients,of ASA physical status Ⅰ or Ⅱ,aged 30-64 yr,with body mass index ＜ 30 kg/m2,scheduled for elective spinal surgery in prone position supported by a Wilson frame under general anesthesia,were randomly allocated to receive mechanical ventilation using either VCV （n =20） or PCV （n =20） mode.Endotracheal intubation and mechanical ventilation were performed after induction of anesthesia.The tidal volume （VT） was set at 10 ml/kg according to the ideal body weight in group VCV.The maximal inspiratory pressure of the anesthesia machine was adjusted to maintain the VT at 10 ml/kg in group P.Both ventilation modes were required to maintain PET CO2 within the normal range.VT,respiratory rate,minute ventilation （MV）,dynamic lung compliance （Cdyn）,peak and mean airway pressure （Ppeak,Pmean）,mean arterial pressure （MAP） and HR were recorded at 10 min after the patients were turned to supine position and at 30 min after the patients were turned to prone position after intubation.Arterial blood samples were collected for blood gas analysis,and oxygenation index（OI） and physiologic dead space fraction （VD/VT） were calculated.Results Compared with those at 10 min after turning to supine position,Ppeak was significantly increased and Cdyn,VT and MV were decreased at 30 min after turning to prone position in both groups.Compared with group VCV,Ppeak was significantly decreased,respiratory rate and Cdyn were increased,and no significant change was found in VT,MV,OI,VD/VT,Pmean,MAP and HR in PCV group.Conclusion Compared with VCV,PCV can improve the ventilatory efficacy and reduce the influence of prone position on respiratory dynamics in the patients undergoing spinal surgery in prone position supported by a Wilson frame.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2014年第11期1354-1356,共3页
Chinese Journal of Anesthesiology
