压力控制容量保证通气模式在围术期肺保护中的研究进展

Research Progress of Pressure-Controlled Volume-Guaranteed Ventilation in Perioperative Lung Protection

摘要: 围术期肺损伤与术后肺部并发症(PPCs)的发生率和死亡率密切相关，优化机械通气策略是降低相关风险的关键环节。压力控制–容量保证通气(PCV-VG)作为一种结合压力控制通气(PCV)与容量控制通气(VCV)特点的混合模式，旨在实现最低气道压力下的精准潮气量输送。本综述系统评价与比较了PCV-VG与传统通气模式在围术期肺保护中的应用价值。现有证据表明，PCV-VG在改善术中呼吸力学方面展现出明确的技术优势，包括降低气道峰值压力、提高肺动态顺应性、提供比PCV更稳定的潮气量。然而，这些优势并未明确转化为患者核心临床结局的显著改善。指出了PCV-VG是一种有价值的精细化通气管理工具，尤其适用于呼吸力学状态复杂多变的场景，但其临床应用应基于对其技术优势与临床结局改善有限性的全面认识，并融入个体化的肺保护性通气策略之中。

Abstract: Perioperative lung injury is closely associated with the incidence and mortality of postoperative pulmonary complications (PPCs), and optimizing mechanical ventilation strategies is a key measure to reduce related risks. Pressure-controlled ventilation-volume guaranteed (PCV-VG), a hybrid mode combining the characteristics of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), is designed to deliver precise tidal volume at the lowest airway pressure. This review systematically evaluates and compares the value of PCVVG versus conventional ventilation modes in perioperative lung protection. Current evidence demonstrates that PCV-VG presents distinct technical advantages in improving intraoperative respiratory mechanics, including reducing peak airway pressure, enhancing dynamic lung compliance, and providing more stable tidal volume compared with PCV. However, these advantages have not been clearly translated into significant improvements in patients’ core clinical outcomes. PCV-VG is recognized as a valuable tool for refined ventilation management, especially suitable for scenarios with complex and variable respiratory mechanics. Nevertheless, its clinical application should be based on a comprehensive understanding of its technical benefits and the limited improvement in clinical outcomes, and integrated into individualized lungprotective ventilation strategies.