CAJ | 학술논문

目的比较Wilson框架固定的俯卧位脊柱手术患者压力控制通气和容量控制通气的效果.方法择期全麻下行脊柱手术并需使用Wilson框架固定的患者40例,ASA分级Ⅰ或Ⅱ级,年龄30 ～ 64岁,BMI＜ 30 kg/m2,采用随机数字表法,将其分为2组(n=20):压力控制通气组(PCV组)和容量控制通气组(VCV组).麻醉诱导后气管插管行机械通气,按理想体重,VCV组设定潮气量10ml/kg,PCV组调节麻醉机最大吸气压力,设定潮气量10 ml/kg.维持呼气末二氧化碳分压在正常范围内.于气管插管后仰卧位10 min、俯卧位30 min时,记录VT、RR、分钟通气量(MV)、肺顺应性(Cdyn)、气道峰压(Ppeak)、气道平均压(Pmean)、MAP和HR.并采集动脉血样,进行血气分析,计算氧合指数(OI)、生理死腔量/潮气量比率(VD/VT).结果与仰卧位10 min时比较,2组俯卧位30 min时Ppeak升高,Cdyn、VT及MV降低(P＜0.05).与VCV组比较,PCV组Ppeak降低,RR、Cydn升高(P＜0.05),VT、MV、OI、VD/VT和Pmean、MAP和HR差异无统计学意义(P＞0.05).结论与容量控制通气比较,压力控制通气可改善Wilson框架固定的俯卧位脊柱手术患者通气效果,减轻俯卧位对呼吸动力学的影响.
목적 비교Wilson광가고정적부와위척주수술환자압력공제통기화용량공제통기적효과.방법 택기전마하행척주수술병수사용Wilson광가고정적환자40례,ASA분급Ⅰ혹Ⅱ급,년령30 ～ 64세,BMI＜ 30 kg/m2,채용수궤수자표법,장기분위2조(n=20):압력공제통기조(PCV조)화용량공제통기조(VCV조).마취유도후기관삽관행궤계통기,안이상체중,VCV조설정조기량10ml/kg,PCV조조절마취궤최대흡기압력,설정조기량10 ml/kg.유지호기말이양화탄분압재정상범위내.우기관삽관후앙와위10 min、부와위30 min시,기록VT、RR、분종통기량(MV)、폐순응성(Cdyn)、기도봉압(Ppeak)、기도평균압(Pmean)、MAP화HR.병채집동맥혈양,진행혈기분석,계산양합지수(OI)、생리사강량/조기량비솔(VD/VT).결과 여앙와위10 min시비교,2조부와위30 min시Ppeak승고,Cdyn、VT급MV강저(P＜0.05).여VCV조비교,PCV조Ppeak강저,RR、Cydn승고(P＜0.05),VT、MV、OI、VD/VT화Pmean、MAP화HR차이무통계학의의(P＞0.05).결론 여용량공제통기비교,압력공제통기가개선Wilson광가고정적부와위척주수술환자통기효과,감경부와위대호흡동역학적영향.
Objective To compare the pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in the patients undergoing spinal surgery in prone position supported by a Wilson frame.Methods Forty patients,of ASA physical status Ⅰ or Ⅱ,aged 30-64 yr,with body mass index ＜ 30 kg/m2,scheduled for elective spinal surgery in prone position supported by a Wilson frame under general anesthesia,were randomly allocated to receive mechanical ventilation using either VCV (n =20) or PCV (n =20) mode.Endotracheal intubation and mechanical ventilation were performed after induction of anesthesia.The tidal volume (VT) was set at 10 ml/kg according to the ideal body weight in group VCV.The maximal inspiratory pressure of the anesthesia machine was adjusted to maintain the VT at 10 ml/kg in group P.Both ventilation modes were required to maintain PET CO2 within the normal range.VT,respiratory rate,minute ventilation (MV),dynamic lung compliance (Cdyn),peak and mean airway pressure (Ppeak,Pmean),mean arterial pressure (MAP) and HR were recorded at 10 min after the patients were turned to supine position and at 30 min after the patients were turned to prone position after intubation.Arterial blood samples were collected for blood gas analysis,and oxygenation index(OI) and physiologic dead space fraction (VD/VT) were calculated.Results Compared with those at 10 min after turning to supine position,Ppeak was significantly increased and Cdyn,VT and MV were decreased at 30 min after turning to prone position in both groups.Compared with group VCV,Ppeak was significantly decreased,respiratory rate and Cdyn were increased,and no significant change was found in VT,MV,OI,VD/VT,Pmean,MAP and HR in PCV group.Conclusion Compared with VCV,PCV can improve the ventilatory efficacy and reduce the influence of prone position on respiratory dynamics in the patients undergoing spinal surgery in prone position supported by a Wilson frame.