【原】【罂粟摘要】婴幼儿俯卧位容量控制通气、压力控制通气和压力控制容量保证通气模式的比较：一项前瞻性随机研究

婴幼儿俯卧位容量控制通气、压力控制通气和压力控制容量保证通气模式的比较：一项前瞻性随机研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：黄祥            编辑：王波          审校：曹莹

目的

探讨压力控制通气（PCV）和压力控制容量保证通气（PCV-VG）在改善俯卧位婴幼儿术中呼吸力学方面是否优于容量控制通气（VCV）。

方法

研究对象为来自浙江大学医学院儿童医院的1月至3岁接受择期脊髓栓系松解术的儿童患者。患者随机分为VCV组、PCV组和PCV-VG组。目标潮气量（VT）为8 mL/kg，调整呼吸频率（RR）以保持恒定的呼末二氧化碳。测量结果：主要结果是术中气道压力峰值（Ppeak）。次要结果包括其他呼吸和通气变量、气体交换值、血清肺损伤生物标志物浓度、血流动力学参数和术后呼吸并发症。

结果

最终分析共纳入120例患者（每组40例）。VCV组在T2（俯卧位10 min）和T3（俯卧位30 min）的Ppeak高于PCV组和PCV-VG组（T2： P = 0.015和P = 0.002；T3： P = 0.007和P=0.009）。与 VCV 相比，PCV 和 PCV-VG 通气模式在T2和T3阶段可防止与俯卧有关的动态顺应性降低（T2： P = 0.008和P = 0.015；T3：P = 0.015和P=0.014）。此外，三组间的其他次要结果没有显著差异。

结论

      对于在俯卧位接受脊髓栓系松解术的婴幼儿来说，PCV-VG可能是一种更好的通气模式，因为它能够缓解Ppeak的增加和动态顺应性的降低，同时可保持稳定的潮气量。

原始文献来源：Bao C,Cao H,Shen Z, et al. Comparison of volume-controlled ventilation, pressure-controlled ventilation and pressure-controlled ventilation-volume guaranteed in infants and young children in the prone position: A prospective randomized study. J Clin Anesth. 2024;95:111440.

Comparison of volume-controlled ventilation, pressure-controlled  ventilation and pressure-controlled ventilation-volume guaranteed in  infants and young children in the prone position: A prospective  randomized study

Study objective: To explore if the pressure-controlled ventilation (PCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes are superior to volume-controlled ventilation (VCV) in optimizing intraoperative respiratory mechanics in infants and young children in the prone position.

Measurements: The primary outcome was intraoperative peak airway pressure (Ppeak). Secondary outcomes included other respiratory and ventilation variables, gas exchange values, serum lung injury biomarkers concentration, hemodynamic parameters and postoperative respiratory complications. 

Main results: A total of 120 patients were included in the final analysis (40 in each group). The VCV group showed higher Ppeak at T2 (10 min after prone positioning) and T3 (30 min after prone positioning) than the PCV and PCV-VG groups (T2: P = 0.015 and P = 0.002, respectively; T3: P = 0.007 and P = 0.009, respectively). The 

prone-related decrease in dynamic compliance was prevented by PCV and PCV-VG ventilation modalities at T2 and T3 than by VCV (T2: P = 0.008 and P = 0.015, respectively; T3: P = 0.015 and P = 0.014, respectively). Additionally, there were no significant differences in other secondary outcomes among the three groups. 

Conclusion: In infants and young children undergoing spinal cord detethering surgery in the prone position, PCV-VG may be a better ventilation mode due to its ability to mitigate the increase in Ppeak and decrease in Cdyn while maintaining consistent VT.

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