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目的评价压力控制-容量保证(PCV-VG)通气策略用于达芬奇机器人肺叶切除术对吸气压力、氧合参数及术后通气结局等方面的影响。方法将2013年6月至2014年12月在我院择期行达芬奇机器人肺叶切除术的40例患者随机分为两组,每组20例。PCV-VG组,男13例、女7例,平均年龄(49.0±5.5)岁,单肺通气采用PCV-VG模式。容量控制通气(VCV)组,男16例、女4例,平均年龄(51.0±3.9)岁,术中采用VCV通气模式。分别在不同时间段记录血流动力学指标和氧合参数,并进行组间比较。结果单肺通气期间PCV-VG组的吸气峰压(Ppeak)显著低于VCV组(P<0.05),肺动态顺应性Cdyn则高于VCV组(P<0.05);两组术前氧合指数(OI)及呼吸指数(RI)无差异,单肺通气阶段PCV-VG组OI明显高于VCV组(P<0.05),RI与动脉血二氧化碳分压(Pa CO2)明显低于VCV组(P<0.05)。结论 PCV-VG通气模式用于达芬奇机器人辅助肺叶切除术单肺通气中比传统的VCV通气模式更能降低吸气压力指标、并改善了氧合参数。
Objective To evaluate the effect of pressure control - volume assurance (PCV-VG) ventilation strategy on inspiratory pressure, oxygenation parameters and postoperative ventilatory outcomes in patients with da Vinci robotic lobectomy. Methods From June 2013 to December 2014, 40 patients undergoing elective aeromedical lobectomy in our hospital were randomly divided into two groups (20 in each group). PCV-VG group, 13 males and 7 females, average age (49.0 ± 5.5) years old, single lung ventilation using PCV-VG mode. In the volume controlled ventilation (VCV) group, there were 16 males and 4 females, with an average age of (51.0 ± 3.9) years. VCV ventilation was used intraoperatively. The hemodynamic parameters and oxygenation parameters were recorded at different time points, and compared between groups. Results The peak inspiratory pressure (Ppeak) in PCV-VG group was significantly lower than that in VCV group during single lung ventilation (P <0.05), while that in Cdyn group was higher than that in VCV group (P <0.05) OI and RI of PCV-VG group were significantly higher than those of VCV group (P <0.05) in one-lung ventilation stage, while RI of RI and PaCO2 in arterial blood group were significantly lower than those in VCV group P <0.05). Conclusions PCV-VG ventilation mode can reduce the inspiratory pressure index and improve the oxygenation parameters more than traditional VCV ventilation mode in da Vinci robot-assisted lobectomy single lung ventilation.