Objective To investigate the effects of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) strategies for the patients undergoing general anesthesia for laparotomy. Methods A total of 70 patients (39 males and 31 females, aged from 65 to 82 years) who underwent general anesthesia for schedualed laparotomy were prospectively subjected in this clinical trial, and they were randomly assigned into PCV group (n=35) and VCV group (n=35). The hemodynamic and respiratory mechanic indices [including heart rate (HR), blood pressure (BP), mean arterial pressure (MAP), peak airway pressure (Ppeak), mean airway pressure (Pmean), tidal volume (VT) and respiratory rate (RR)] were measured at the following time points, pre-intubation (T₀), 3 min after intubation (T₁), immediately after surgery began (T₂), 2 h after surgery (T₃), end of surgery (T₄), and 5 min post-extubation (T₅). The radial arterial blood gas analyses were tested at T₀, T₁, T₃ and T₅. Pulmonary and extrapulmonary complications during hospitalization were recorded. Results Eight patients were excluded and the other 62 patients were enrolled in this trial, including 30 patients for PCV group and 32 patients for VCV group. The level of Ppeak was significantly lower in the PCV group than in the VCV group at T₂, T₃ and T₄ (P<0.05). From the beginning of operation, HR and MAP were in a trend of decreasing. Compared with the group VCV, the PCV group had comparatively higher MAP level at T₂, T₃ and T₄, and reached the summit at T₄, but the level of lactic acid was the lowest at T₃ (P<0.05). The pH, PaO₂ and oxygenation index (OI) values were obviously decreased in the both groups at T₅ than at T₀ (P<0.05). Significant difference was observed in the length of hospital stay in the PCV group and VCV group [(18.3±5.3) vs (15.6±4.5)d, P=0.045]. There were 2 of 30 patients (6.7%) in group PCV and 9 of 32 patients (28.1%) in group VCV admitted to the intensive care unit (ICU), with significant difference between them (P<0.05).Conclusion PCV model as lung protective ventilation strategy can lead lower airway pressure and obtain similar OI and PaO₂, and is beneficial to the aged patients undergoing general anesthesia for laparotomy.