| Background: In recent years, laparoscopic operations widely applied in clinical practice. However, laparoscopic surgery is performed under the state of pneumoperitoneum, and patients are placed in a special posture, which may lead to the pathophysiological change of body. As for ventilation, it mainly causes the decrease of thorax lung compliance and obvious changes of dead space volume as well as intrapulmonary shunt; As for breath, it mainly causes the increase of arterial partial pressure of carbon dioxide; As for the haemodynamic changes induced by laparoscopic operation, cardiac output is decreased, arterial blood pressure is increased, systemic circulation and pulmonary vascular resistance are increased, heart rate remains unchanged or slightly increased. These factors make the anesthesia management of laparoscopic operation be more complex than that of open operation, and the risk of anesthesia is increased. There is many kinds of methods to ensure the stability of respiratory and circulatory system for anesthetists, such as adjusting the respiratory parameters, implementation of recruitment maneuvers, but these methods will more or less cause adverse reactions. Adjusting the ventilation mode can be used as a protective ventilation strategy. Volume controlled ventilation(VCV) and pressure controlled ventilation(PCV) are two most common ventilation modes during the operation. It remains controversial to which kind of ventilation mode is more suitable for laparoscopic operation.Objective: To investigate which kind of ventilation mode, pressure control ventilation(PCV) or volume controlled ventilation(VCV) is more suitable for laparoscopic surgery and meta-analysis.Methods: Until December 31 st 2014, the relevant key words were used to retrieve in Cochrane controlled trials central registry(CENTRAL), Pubmed, EMBASE and Web of Science(WOS) databases.Only randomized controlled clinical trial was included. The included literature standard was the patients undergoing laparoscopic operation under general anesthesia. The PCV and VCV were compared in the surgery. The hemodynamic index, pulmonary ventilation, mechanics of lung or postoperative respiratory complications were reported during pneumoperitoneum. Exclusion criteria: 1) The patients participating in literature research have serious respiratory or circulatory system diseases; 2) The laparoscopic operation was changed to open operation halfway; 3) The intraoperative laparoscopic operation related complications such as subcutaneous emphysema, air embolism appeared; 4) The animal research was not taken into consideration; 5) The non English literature was excluded. The main measurement indexes of this article including oxygenation index, arterial partial pressure of carbon dioxide and pulmonary dynamic compliance, the secondary measurement is mean arterial pressure and heart rate.Results: A total of 10 studies were selected. The sample size was 518, including 259 in PCV group and 259 in VCV group. ASA I-â…¡. The analysis results showed that MD of OI was 12.34. Its 95% confidence interval was-6.94~31.63. MD of Pa CO2 was-1.17. Its 95% confidence interval was-2.34~-0.00. MD of the pulmonary dynamic compliance was 3.01. Its 95% confidence interval was 2.11~3.90. MD of MAP was 0.96. Its 95% confidence interval was-0.93~2.85; MD of HR was-1.34. Its 95% confidence interval was-3.44~0.77.Conclusion: As for patients in good cardiopulmonary function received laparoscopic surgery, PCV may provide better dynamic lung compliance; But there was no significant difference between the effects of two ventilation modes on OI, Pa CO2 and hemodynamics. This conclusion still needs more large sample randomized trial to prove. |
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