摘要
目的:探讨压力控制容量通气在患者脊柱手术中的临床效果及对血流动力学的影响。方法:前瞻性选择医院收治的110例脊柱手术患者,按随机数表法将其分为对照组和观察组,每组55例。对照组手术采用容量控制通气(VCV)模式,观察组手术采用压力控制容量通气模式。记录并统计两组气管插管前后心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排量(CO)及体循环血管阻力指数(SVRI)血流动力学参数;记录并统计两组气管插管前后潮气量、分钟通气量、气道峰压、平均气道压、呼吸末二氧化碳分压水平及动态肺顺应性;采用放射免疫分析法测定白细胞介素-6(IL-6)水平;采用双抗夹心免疫发光法测定降钙素原(PCT)水平;采用全自动生化分析仪测定C反应蛋白(CRP)水平。结果:观察组气管插管后HR、体循环血管阻力指数与对照组比较差异无统计学意义;观察组气管插管后MAP、CVP及CO均高于对照组,差异有统计学意义(t=6.434,t=3.776,t=0.024;P<0.05);观察组气管插管后气道峰压、平均气道压水平低于对照组,差异有统计学意义(t=6.434,t=3.776;P<0.05);观察组气管插管后动态肺顺应性水平高于对照组,差异有统计学意义(t=6.983,P<0.05);观察组气管插管后IL-6、PVT及CRP水平均低于对照组,差异具有统计学意义(t=36.545,t=25.442,t=14.545;P<0.05)。结论:将压力控制容量通气模式用于患者脊柱手术中效果理想,有助于改善患者血流动力学、呼吸末二氧化碳分压,能降低炎症因子水平。
Objective： To investigate the influence of pressure-controlled volume ventilation on clinical effect and hemodynamics of undergoing spinal surgery. Methods： A total of 110 patients who would undergo spine surgery were selected in this prospective study and all of them were randomly divided into control group （55 cases） and observation group （55 cases） according to the random number table method. The control group adopted volume-controlled ventilation （VCV） mode, while the observation group adopted pressure-controlled ventilation mode. The hemodynamics parameters included heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP）, cardiac output （CO） and systemic vascular resistance index （SVRI） before and after intubation were recorded and analyzed by statistics method. And the tidal volume, minute ventilation, peak airway pressure, mean airway pressure, end-tidal carbon dioxide partial pressure and dynamic lung compliance before and after tracheal intubation were measured and recorded. The interleukin-6 （IL-6） level was measured by radioimmunoassay. The procalcitonin （PCT） level was measured by double-antibody sandwich immunoassay. And C-reactive protein （CRP） level was measured by automatic biochemical analyzer. Results： The differences of HR and SVRI post tracheal intubation between the two groups were no significant. After tracheal intubation, the MAP, CVP and CO of observation group were significantly higher than those of control group （t=6.434, t=3.776, t=0.024, P〈0.05）, respectively. And after tracheal intubation, the peak airway pressure and mean airway pressure level of observation group were significantly lower than those of control group （t=6.434, t=3.776, P〈0.05）. And the dynamic lung compliance level post tracheal intubation of observation group was significantly higher than that of control group （t=6.983, P〈0.05）. Besides, the IL-6, PVT and CRP levels post tracheal intubation of observation group were significantly lower than those of control group （t=36.545, t=25.442, t=14.545, P〈0.05）. Conclusion： The pressure-controlled ventilation mode obtains ideal effect in implementing spine surgery for patients, and it can help to improve hemodynamics and end-tidal carbon dioxide partial pressure, and can reduce the inflammatory factor level. Therefore, it is worth to be popularized.
作者
王玉
王清秀
张清
WANG Yu;WANG Qing-xiu;ZHANG Qing(Department of Aesthesia,Tongji University School of Medicine.Department of Aesthesia,Zhabei Center Hospital of Jingan District of Shanghai City,Shanghai 20012,China.)
出处
《中国医学装备》
2018年第11期105-108,共4页
China Medical Equipment
关键词
压力控制容量通气模式
容量控制通气模式
脊柱手术
临床效果
血流动力学
Pressure-controlled volume ventilation mode
Volume-controlled ventilation mode
Spinal surgery
Clinical effect
Hemodynamics
