【摘要】 目的观察等比通气对压力控制通气-容量保证（PCV-VG）通气模式下肥胖妇科患者腹腔镜手术中的呼吸力学和肺换气功能的影响。方法择期行全凭静脉麻醉下腹腔镜手术的肥胖妇科患者60例随机均分为两组。均行PCV-VG模式通气,设置呼吸频率16次/分,呼气末正压（PEEP）6cmH₂O,吸入氧浓度50%,A组吸呼比1∶2,B组1∶1。于气管插管后即刻（T0）、腹腔充气且头低位后即刻（T1）、头低位后30min（T2）和头低位后60min（T3）记录PaO₂、PaCO₂、PETCO₂、气道峰压(P_peak)、气道平均压(P_mean)、胸肺顺应性（CRS）,计算氧合指数（OI）、动脉-呼气末二氧化碳分压差(D_a-ETCO₂)、死腔率（VD/VT）和肺泡-动脉血氧分压差(D_A-aO₂)。记录两组患者发生皮下气肿、低血压、心动过缓、苏醒延迟、术后肺不张等不良反应发生情况。结果与A组比较,T2、T3时B组P_mean、CRS、OI升高,P_peak、D_a-ETCO₂、VD/VT、D_A-aO₂均降低（P<0.05）。结论等比通气可改善PCV-VG通气模式下肥胖妇科患者腹腔镜手术中的呼吸力学和肺换气功能。更多还原

【Abstract】 Objective To observe the effects of equal ratio ventilation with pressure control ventilation with volume guarantee（PCV-VG）ventilation mode on respiratory mechanics and pulmonary gas exchange function in obese gynecologic patients undergoing laparoscopic surgery.Methods Sixty obese gynecologic patients undergoing laparoscopic surgery under total intravenous general anesthesia were randomly divided into two groups with 30 cases each.The PCV-VG ventilation mode was used and the parameters were set up as RR 16 times per minute,PEEP 6 cmH₂O,and FiO₂50%.The ratio of inspiration to expiration for group A was 1∶2 and that for group B was 1∶1.The PaO₂,PaCO₂,PETCO₂,peak airway pressure(P_peak),mean airway pressure(P_mean),and respiratory system compliance（CRS）were recorded and oxygenation index（OI）,arterial to end-tidal difference in carbon dioxide(D_a-ETCO₂),dead space/tidal volume ratio（VD/VT）and alveolar-arterial oxygen partial pressure difference(D_A-aO₂)were calculated at the time points of immediately after intubation（T0）,abdominal inflation with head-down position（T1）,at 30 minutes（T2）and 60 minutes（T3）during head-down position.The incidence of adverse responses such as subcutaneous emphysema,hypotension,bradycardia,delayed awakening,atelectasis and were recorded.Results Compared with group A,group B had higher P_mean,CRS and OI,lower P_peak,D_a-ETCO₂,VD/VT and D_A-aO₂ at T2 and T3（P<0.05）.Conclusion Equal ratio ventilation with PCV-VG ventilation mode can improve respiratory mechanics and pulmonary gas exchange function in obese gynecologic patients undergoing laparoscopic surgery.更多还原