Abstract:Objective: To analyze the effect of the pressure-controlled volume-guaranteed (PCV-VG) mode on the correlation between PaCO2 and PetCO2 during one lung ventilation. Methods: A total of 60 patients with radical resection of esophageal carcinoma were selected, aged 35-65 yr, were divided into 2 groups (n=30 each) using a random number table: volume-controlled ventilation group (group V) and PCV-VG group (group P). The ventilator settings were adjusted, with a tidal volume 8 mL/kg and respiratory rate 12 breaths/min during two-lung ventilation (TLV), and with a tidal volume 6 mL/kg and respiratory rate 15 breaths/min during OLV. The inspiratory/expiratory ratio was 1:2 and 75% fraction of inspired oxygen(FiO2) at 1.5L/min. Arterial blood gas analysis and respiration parameter were determined 15 minutes after TLV (T0), 15 min (T1), 30 min (T2), 60 min (T3), 90 min (T4) after OLV. Results: Ppeak and Pplat in group V were higher than that in group P at all time points.There was no statistical difference in PaO2 between the two groups at each time point (P=0.612), and PaO2 at t1-t4 was lower than that of the same group (P <0.001).The correlation coefficient between PaCO2 and PetCO2 in P group was higher than that in V group at each time point, but the correlation between PaCO2 and PetCO2 in the other two groups was lower than that in T0 group. Conclusion: Compared with VCV ventilation, single lung ventilation with PCV-VG model can better maintain the correlation between PaCO2 and PetCO2. Compared with double lung ventilation, the correlation between PaCO2 and PetCO2 in the two ventilation modes are both decreased. In addition, the PCV-VG model can effectively reduce the peak airway pressure and airway plateau pressure and reduce the risk of lung pressure injury while ensuring oxygen supply. It can be safely used in one-lung ventilation after radical resection of esophageal cancer.
王坤, 王莉萍, 胡杰, 孙艳斌, 张承民. PCV-VG模式对单肺通气患者术中PaCO2与PetCO2相关性影响的研究[J]. 河北医学, 2019, 25(1): 167-170.
WANG Kun, WANG Liping, et al. Effect of PCV-VG Mode on Correlation between PaCO2 and PetCO2 During One-lung Ventilation. HeBei Med, 2019, 25(1): 167-170.
[1] 王金荣,邵立业等.机械通气患者呼气末二氧化碳分压与动脉血二氧化碳分压的相关性研究[J].中国呼吸与危重监护杂志,2018,17(1):71~75. [2] Blidner AG,Salatino M,Mascsnfroni ID,et al.Different response of myeloid-derived suppressor cells to the nonsteroidal anti-inflammatory agent indomethacin in tumor-associated and tumor-free microenvironments[J].Immunol,2015,194(7):3452~3462. [3] 高有俊.临床麻醉中呼气末二氧化碳分压监测的临床应用及意义[J].中国实用医药,2017,12(29):70~71 [4] Monu Yadav, Elmati Praveen Reddy,et al.The Effect of Position on PaCO 2 and PETCO 2 in Patients Undergoing Cervical Spine Surgery in Supine and Prone Position[J].Neurosurg Anesthesiol, 2017,29(3):298~303. [5] Jens Lohser,Peter Slinger,et al.Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung[J].Anesthesia & Analgesia, 2015,121 (2) :302~318 [6] Ghabach MB,Elie M EI Hajj,et al.Ventilation of nonparalyzed patients under anesthesia with laryngeal mask airway,comparison of three modes of ventilation:Volume controlled ventilation,pressure controlled ventilation,and pressure controlled ventilation-volume guarantee[J].2017,11(1):197~200. [7] Song SY,Jung JY,Cho MS,et al.Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation[J].Korean Anesthesiol,2014,67(4):258~263. [8] Osama M,Assad MD,et al.Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position[J].Jounrnal of Clinical Anesthesia,(2016),34,55~61. [9] 江飞,金孝岠,刘灿,等.压力控制容量保证通气模式对全麻患者呼吸力学的影响[J].临床麻醉学杂志,2014,30(4):377~379. [10] Wenjun Liu,Qian Huang,et al.Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection[J].Thoracic Disease,2018,10(5):2760~2770. [11] 李梦怡,李云,胡宪文,等.PCV-VG用于胸腔镜单肺通气患者肺保护性通气的效果[J].中华麻醉学杂志,2017,37(2):155~158.