本文選題：壓力調(diào)節(jié)容量控制通氣 + 腹腔鏡　； 參考：《實(shí)用醫(yī)學(xué)雜志》2017年03期

【摘要】：目的:通過在氣腹過程中對(duì)PC、VC和PRVC 3種呼吸模式進(jìn)行呼吸力學(xué)的監(jiān)測(cè)并、對(duì)比、研究,來探討PRVC呼吸模式臨床使用的意義及價(jià)值。方法:腹腔鏡膽囊切除術(shù)患者90例,隨機(jī)分為壓力控制、容量控制、壓力調(diào)節(jié)容量控制通氣3組,每組30例。分別在患者氣腹前、氣腹后5、10、15、20 min等5個(gè)時(shí)項(xiàng)段記錄:食管壓力、氣道平均壓、氣道壓峰值、動(dòng)脈二氧化碳分壓、呼氣末CO_2濃度或分壓、潮氣量、平均動(dòng)脈壓、心率。結(jié)果:VC模式的PES在氣腹后明顯高于PC和PRVC模式。PC和VC模式氣腹后10 min開始PaCO_2和ETCO_2明顯升高(P0.05);PC不僅會(huì)使PaCO_2和ETCO_2升高,而且氣腹后TV明顯低于其他兩組(P0.05)。PC和VC組氣腹后通過使PaCO_2和ETCO_2上升,使MAP、HR顯著升高(P0.05)。氣腹后PRVC組MAP、HR顯著低于PC、VC組(P0.05)。結(jié)論:PRVC模式可有效降低氣腹引起的PAWM、PAP、PES升高,避免PaCO_2和ETCO_2在手術(shù)期的異常升高,保證圍手術(shù)期患者的生命體征平穩(wěn)。
[Abstract]:Objective: to monitor the respiratory mechanics of the 3 breathing patterns of PC, VC and PRVC during the pneumoperitoneum, compare and study the significance and value of the clinical use of PRVC breathing patterns. Methods: 90 cases of laparoscopic cholecystectomy were randomly divided into 3 groups of pressure control, volume control, and pressure regulating capacity control ventilation, 30 cases in each group. Before pneumoperitoneum, 5 time items such as 5,10,15,20 min after pneumoperitoneum were recorded: esophageal pressure, airway mean pressure, airway pressure peak, arterial carbon dioxide pressure, end expiratory CO_2 concentration or partial pressure, tidal volume, mean arterial pressure, heart rate. Results: VC mode PES was significantly higher than PC and PRVC mode.PC and VC mode pneumoperitoneum after pneumoperitoneum, and 10 min began PaCO_2. And ETCO_2 significantly increased (P0.05); PC not only makes PaCO_2 and ETCO_2 increase, but TV is significantly lower after pneumoperitoneum than the other two groups (P0.05).PC and VC group. PES increased to avoid abnormal elevation of PaCO_2 and ETCO_2 during operation, and to ensure stable vital signs during perioperative period.

【作者單位】： 內(nèi)蒙古大學(xué)生命科學(xué)院;內(nèi)蒙古包鋼醫(yī)院;
【基金】：國家自然科學(xué)基金資助項(xiàng)目(編號(hào):81560251)
【分類號(hào)】：R657.4

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