医师在线2024，Vol.14Issue(12) ：72-75.

VCV与PCV-VG模式对腹腔镜全子宫切除术患者膈肌功能的影响

Effects of VCV and PCV-VG modes on diaphragmatic function in patients undergoing laparoscopic total hysterectomy

张京 吴浩云 韩孟和
医师在线2024，Vol.14Issue(12) ：72-75.
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VCV与PCV-VG模式对腹腔镜全子宫切除术患者膈肌功能的影响

Effects of VCV and PCV-VG modes on diaphragmatic function in patients undergoing laparoscopic total hysterectomy

张京 1吴浩云 1韩孟和1
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作者信息

  • 1. 泗洪县第一人民医院麻醉科,江苏宿迁 223900
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摘要

目的 探讨容量控制通气(VCV)与压力控制-容量保证通气(PCV-VG)模式对腹腔镜全子宫切除术患者膈肌功能的影响.方法 选取2022年1月～2023年11月我院收治的计划行腹腔镜全子宫切除术的60例患者作为研究对象,按照随机抽签法将其分为观察组(n=30)和对照组(n=30).进入手术室后,两组患者均常规连接动态血压心电监护仪,对照组采用VCV模式进行通气,观察组采用PCV-VG模式进行通气,比较两组患者麻醉前(T0)、气管插管术后10 min(T1)、建立气腹30 min(T2)以及解除气腹后20 min(T3)的血流动力学指标,采用超声检测两组患者通气前及通气后的膈肌功能状态,比较两组患者通气前及通气后的炎症因子水平.结果 T1、T2 和T3 时,两组患者的平均动脉压(MAP)均较T0 时显著下降(P＜0.05),心率(HR)及动脉血氧分压(PaO2)较T0 时无显著差异(P＞0.05);通气后,两组最大吸气压、最大呼气压、最大跨膈压均较通气前显著上升(P＜0.05),且观察组最大吸气压显著高于对照组(P＜0.05);通气后,两组降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)均较通气前显著下降(P＜0.05),且观察组的PCT、CRP、WBC均显著低于对照组(P＜0.05).结论 在PCV-VG模式下,腹腔镜全子宫切除术患者的膈肌功能显著提高,且可有效降低炎症水平.

Abstract

Objective To investigate the effects of volume-controlled ventilation(VCV)mode and pressure controlled ventilation-volume guaranteed(PCV-VG)mode on diaphragmatic function in patients undergoing laparoscopic total hysterectomy.Methods A total of 60 patients who were admitted to our hospital from January 2022 to November 2023 and planned to undergo laparoscopic total hysterectomy were selected as the subjects of this study.They were divided into observation group(n=30)and control group(n=30)according to the random lottery method.After entering the operating room,the two groups of patients were routinely connected to the ambulatory blood pressure ECG monitor.The control group was ventilated with VCV mode,and the observation group was ventilated with PCV-VG mode.The hemodynamic indexes of the two groups before anesthesia(T0),10 min after tracheal intubation(T1),30 min after establishing pneumoperitoneum(T2)and 20 min after relieving pneumoperitoneum(T3)were compared.The diaphragm function of the two groups before and after ventilation was detected by ultrasound.The levels of inflammatory factors before and after ventilation were compared between the two groups.Results The mean arterial pressure(MAP)at T1,T2 and T3 was significantly lower than that at T0 in both groups(P<0.05),and there was no significant difference in heart rate(HR)and arterial partial pressure of oxygen(PaO2)compared with T0(P>0.05).After ventilation,the levels of the maximum inspiratory pressure,maximum expiratory pressure and maximum trans-diaphragmatic pressure in the two groups were significantly higher than those before ventilation(P<0.05),and the maximum inspiratory pressure in the observation group was significantly higher than that in the control group(P<0.05).After ventilation,the levels of procalcitonin(PCT),C-reactive protein(CRP)and white blood cell count(WBC)in the two groups were significantly lower than those before ventilation(P<0.05),and the levels of PCT,CRP and WBC in the observation group were significantly lower than those in the control group(P<0.05).Conclusion In the PCV-VG mode,the diaphragmatic function of patients undergoing laparoscopic total hysterectomy is significantly improved,and can effectively reduce the level of inflammation.

关键词

容量控制通气/压力控制-容量保证通气/腹腔镜/全子宫切除术/膈肌功能

Key words

Volume-controlled ventilation/Pressure controlled ventilation-volume guaranteed/Laparoscopic/Total hysterectomy/Diaphragmatic function

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出版年

2024
医师在线

医师在线

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