Effect of pressure-controlled ventilation-volume guaranteed on lung ventilation in elderly patients undergoing laparoscopic Trendelenburg postural colon surgery

Abstract

Objective To observe the effect of pressure-controlled ventilation volume guaranteed (PCV-VG) on lung ventilation in elderly patients undergoing Trendelenburg position laparoscopic colon surgery.

Methods Total 60 patients with colon surgery in Wenzhou Integrated Traditional Chinese and Western Medical Hospital from May 2020 to April 2021 were randomly divided into volume control ventilation group (V group, n = 30) and PCV-VG group (P group, n = 30). The mean arterial pressure (MAP), heart rate (HR), dynamic compliance (Cdyn), inspiratory peak pressure (Ppeak), plateau airway pressure (Pplat) and the partial pressure of endtidal carbon dioxide (PetCO ₂) were recorded at different time point (T1–T6). The pH, PaO ₂ and PaCO ₂ were determined by blood gas analysis and oxygenation index (OI) and pulmonary complications were calculated within 5 days after operation.

Results There was no statistical significance in MAP and HR between V and P group. The HR at T1–T6 in both groups was higher than that in T0 ( P<0.05). Patients in both groups with T4 and T5 had lower PH compared to T1. The PaO ₂ and OI decreased and PaCO ₂ increased in both group with the increase in body position change time ( P<0.05). In T5, compared with P group, the PaO ₂ and OI values were decreased while PaCO ₂ values increased in V group. At T3–T6, Ppeak and Pplat were increased and Cdyn decreased in V group compared with p group. The Cdyn at T4–T5 in P group was decreased compared with V group. At the time point of T5: Ppeak value was (25.4±2.1) cm H ₂O (1 cm H ₂O = 0.098 kPa) in V group vs. (16.3±2.1) cm H ₂O in P group; the Pplat value was (9.0±0.5) cm H ₂O in V group vs. (7.0±0.6) cm H ₂O in P group, and the Cdyn value was (33.2±6.3) mL/cm H ₂O in V group vs. (40.3±5.2) mL/cm H ₂O in P group. The percentage of hypercapnia in group P (3.3%, 1/30) was lower than that in group V (23.3%, 7/30), but the difference was not statistically significant (χ ² = 3.606, P=0.057).

Conclusion PCV-VG can effectively reduce airway pressure of lung ventilation, improve oxygenation index and reduce postoperative complications for elderly patients undergoing laparoscopic Trendelenburg colon surgery.

Abstract

摘要：目的 观察压力控制容量保证通气 (PCV-VG) 对 Trendelenburg 体位腹腔镜结肠手术老年患者肺通气的影 响。 方法 选择 2020 年 5 月 一2021 年 4 月温州市中西医结合医院结肠手术患者 60 例, 以随机数字表法分为容 量控制通气组(V 组) 30 例和 PCV-VG 组(P组) 30 例。记录各时点(T1~T6)的平均动脉压(MAP)、心率(HR)、动态肺顺应性(Cdyn)、气道峰压(Ppeak)、气道平台压(Pplat)和呼气末二氧化碳分压(PetCO ₂)。记录术中pH、PaO ₂及PaCO ₂, 计算氧合指数(OI), 观察术后 5 d 内肺部并发症情况。 结果 2 组患者组间各时点 MAP 及 HR 差异无统计学意义, 2 组 T1~T6 的 HR 均比 T0 增加(均 P<0.05)。与 T1 比较, 2 组患者 T4 和 T5 时 pH 降低。随 体位变换时间增加, 2 组患者 PaO ₂ 下降, PaCO ₂ 上升, OI 下降(均 P<0.05)。在 T5 时, 组间比较, V 组 PaO ₂ 及 OI 低于 P 组。在 T3~T6, V 组 Ppeak 及 Pplat 升高, Cdyn 下降; T4~T5, P 组 Cdyn 下降。在 T5 时, V 组 Ppeak 值 [(25.4±2.1)cm H ₂O vs. (16.3±2.1) cm H ₂O, 1 cm H ₂O = 0.098 kPa]、Pplat 值 [(9.0±0.5) cm H ₂O vs. (7.0±0.6) cm H ₂O] 高于 P 组, Cdyn 值 [33.2±6.3) mL/cm H ₂O vs. (40.3±5.2) mL/cm H ₂O] 低于 P 组。P 组高碳酸 血症发生率[3.3% (1/30)]比 V 组 [23.3%(7/30)] 低, 差异无统计学意义 (χ ² = 3.606, P = 0.057)。 结论 PCV-VG 适用于腹腔镜下 Trendelenburg 体位结肠手术老年患者, 可降低气道压, 提高氧合指数, 减少术后并发症。