PCV中吸气流速对OLV患者呼吸功能及炎症因子的影响  

Effects of different inspiratory velocity during pressure-controlled ventilation on respiratory function and inflammatory factors in patients with one-lung ventilation

作　　者：秦新磊 殷姜文 樊世文 张成超 张钰 代志刚[1] QIN Xinlei;YIN Jiangwen;FAN Shiwen;ZHANG Chenchao;ZHANG Yu;DAI Zhigang(Department of Anesthesiology,First Affiliated Hospital,School of Medicine,Shihezi University,Shihezi 832008,China)

机构地区：[1]石河子大学医学院第一附属医院麻醉科,石河子832008

出　　处：《广州医药》2020年第6期38-45,共8页Guangzhou Medical Journal

基　　金：石河子大学科研计划项目(ZZZC201709A)。

摘　　要：目的比较压力控制通气(PCV)中不同吸气流速对单肺通气(OLV)患者呼吸功能及炎症因子的影响。方法本研究为2018—2019年对75例单肺通气患者的前瞻性研究。患者在麻醉和单肺通气(OLV)后随机分为吸气流量30 L/min(A组)、50 L/min(B组)或70 L/min(C组)。比较OLV前(T0)、OLV后30 min(T1)、60 min(T2)和120 min(T3)的呼吸力学、呼吸功能、血流动力学和血气分析,中心静脉血检测分析IL-6、IL-8、TNF-α和sICAM-1,观察术后3天肺部并发症和ARDS的发生情况。结果三组一般情况、血流动力学指标差异均无统计学意义(P>0.05);B组、C组PaCO2较A组降低(P<0.05);与T0时比较,T1-T3时三组PaO2、SVO2均降低(P<0.05);三组PH、SO2和HB差异均无统计学意义(P>0.05)。与A组比较,B组、C组ΔVT增大(P<0.05);三组Ppeak差异无统计学意义;与A组比较,B组、C组PEEP均增大(P<0.05);与A组比较,T1-T3时B组、C组VD/VT减少(P>0.05);与T0比较,T1-T3时三组Qs/Qt增加(P<0.05);与A组比较,T1-T3时B组、C组Cdyn增大(P<0.05);与T0相比,T1-T3时三组PaO2/FiO2降低(P<0.05);与T0相比,T1-T3时三组IL-6、IL-8、TNF-α和sICAM-1的浓度增多(P<0.05),但A组、B组低于C组(P<0.05)。三组患者发生术后肺部并发症和ARDS差异均无统计学意义。结论在PCV模式下通过增加吸气流速能增加VT,减少死腔率,促进CO2的交换,并且改善肺动态顺应性,但并不能很好的改善氧合及肺内分流。吸气流速50 mL/L在较小炎症反应的情况下达到上述改善呼吸功能和呼吸力学,可推荐应用于进行OLV患者。Objective The effects of different inspiratory velocity PCV on respiratory function and inflammatory factors in patients with one-lung ventilation OLV were compared.Methods This was a prospective study of 75 patients with one-lung ventilation in 2018-2019.The subjects were randomized to the inspiratory velocity 30(group A),50(group B)or 70(group C)L/min after anesthesia and one-lung ventilation OLV.Respiratory mechanics,respiratory function,hemodynamics and blood gas parameters were compared between the three groups pre-OLV(T0)and after 30(T1),60(T2),and 120(T3)minutes of OLV.Center venous blood was collected to measure interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-α,andsoluble intercellular adhesion molecule-1 levels.Observation of pulmonary complications and occurrence of ARDS 3 days after operation were made.Results Hemodynamic and general patient status were similar between the three groups(all P>0.05).PaCO2was lower in the group B and group C compared with the group A(P<0.05).Compared with T0,PaO2 and SVO2 were lower at T1-T3 of the three groups(P<0.05).PH,SO2 and HB were similar between the three groups(all P>0.05).ΔVTwas higher in the group B and group C compared with the group A(P<0.05);Ppeak were similar between the three groups(all P>0.05).PEEPwas higher in the group B and group C compared with the group A(P<0.05);VD/VT decreased in the group B and group C compared with the group A(P<0.05).Compared with T0,Qs/Qt increased at T1-T3 of the three groups(all P<0.05).Cdyn increased at T1-T3 of the group B and group C(all P<0.05).PaO2/FiO2 decreased at T1-T3 of the three groups(all P<0.05).Compared with T0,the concentrations of Il-6,Il-8,TNF-αand sICAM-1 increased at T1-T3 of three groups(P<0.05),and in group A and group B were lower than those in group C(P<0.05).The number of patients who had postoperative pulmonary complications PPCS or acute respiratory distress syndrome(ARDS)were similar between the three groups(all P>0.05).Conclusion In PCV mode,it can increase VT by increasing the inspiratory vel

关 键 词：吸气流速 炎症因子 压力控制通气 单肺通气 

分 类 号：R614[医药卫生—麻醉学]