Pressure-Controlled Ventilation with Volume Guarantee Compared to Volume-Controlled Ventilation with Equal Ratio in Obese Patients Undergoing Laparoscopic Hysterectomy.
Pressure-Controlled Ventilation with Volume Guarantee Compared to Volume-Controlled Ventilation with Equal Ratio in Obese Patients Undergoing Laparoscopic Hysterectomy.
复制标题
DOI：
10.4103/aer.aer_82_19
复制
发表时间：
2019-04-01
期刊：
影响因子：
--
通讯作者：
Nabil, Hanan
中科院分区：
文献类型：
--
作者：
Gad, Mona;Gaballa, Khaled;Nabil, Hanan
背景技术背景：腹腔镜子宫切除术，特别是肥胖患者，需要头低位和二氧化碳气腹，这可能会影响心肺功能。本研究旨在比较压力控制通气与容量保证（PCV-VG）和容量控制通气（VCV）与等比通气（ERV）的影响，即，我：患者和方法：将80名体重指数（BMI）>30 kg/m2且身体状况符合美国麻醉医师协会I级和II级接受腹腔镜子宫切除术的女性随机分配至PCV-VG（P组）或VCV + ERV（V组）。在4个时间点记录通气参数、血流动力学和动脉血气（ABG）分析：（T1）：麻醉诱导后仰卧位10 min，（T2和T3）：分别在CO2气腹和Trendelenburg体位后30和60 min，和（T4）：在放气和恢复仰卧位后。P组的吸气峰压显著低于V组，而动态顺应性显著高于V组。两组之间的ABG分析、氧合和血流动力学数据无显著差异。在接受腹腔镜子宫切除术的肥胖女性中，PCV-VG上级优于VCV和ERV，因为它提供了更高的动态顺应性和更低的吸气峰压，这可能是优选的，特别是在心肺功能更容易受损的患者中。
BACKGROUND: Laparoscopic hysterectomy operations especially for obese patients necessitate Trendelenburg position and pneumoperitoneum with carbon dioxide, which could affect cardiac and pulmonary functions. The present study aimed to compare the impact of pressure-controlled ventilation with volume-guaranteed (PCV-VG) and volume-controlled ventilation (VCV) with equal ratio ventilation (ERV), i.e., I: E ratio of 1:1 on hemodynamics, respiratory mechanics, and oxygenation.PATIENTS AND METHODS: Eighty females with body mass index (BMI) >30 kg/m2 and with physical status American Society of Anesthesiologists Classes I and II undergoing laparoscopic hysterectomy were allocated randomly to either PCV-VG (Group P) or VCV with ERV (Group V). The ventilation parameters, hemodynamics, and arterial blood gases (ABGs) analysis were recorded at four times: (T1): after the anesthetic induction while in supine position by 10 min, (T2 and T3): after the CO2 pneumoperitoneum and Trendelenburg positioning by 30 and 60 min, respectively, and (T4): after desufflation and resuming the supine position.RESULTS: The peak inspiratory pressure in Group P recorded significant lower values than in Group V while the dynamic compliance was greater significantly in Group P than in Group V. No significant differences were reported as regards the ABG analysis, oxygenation, and hemodynamic data between both groups.CONCLUSION: In obese females undergoing laparoscopic hysterectomy surgeries, PCV-VG was superior to VCV with ERV as it provided higher dynamic compliance and lower peak inspiratory pressure that could be preferable, especially in those patients in whom cardiopulmonary function could be more susceptible to impairment.