压力控制容量保证通气模式对肺切除术患者术后肺部并发症的影响  

Effect of pressure control ventilation with volume guarantee mode on postoperative pulmonary complications in patients undergoing pulmonary resection

作　　者：左贞艳 张洁 陈泳伊 顾连兵[2] 徐建国 段满林 ZUO Zhenyan;ZHANG Jie;CHEN Yongyi;GU Lianbing;XU Jianguo;DUAN Manlin(Department of Anesthesiology,Affiliated Jinling Hospital,Medicine School of Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院麻醉科,210002 [2]江苏省肿瘤医院麻醉科

出　　处：《临床麻醉学杂志》2021年第6期569-573,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察压力控制容量保证(PCV-VG)通气模式对肺切除术患者术后肺部并发症(PPCs)的影响。方法选择择期全麻下行胸腔镜肺切除术患者42例,男19例,女23例,年龄18~65岁,ASAⅠ或Ⅱ级。将患者随机分为两组:自双肺通气开始至手术结束始终使用PCV-VG模式通气组(P组)和始终使用容量控制通气(VCV)模式通气组(V组),每组21例。P组双肺通气期间V_(T) 8 ml/kg,单肺通气(OLV)期间V_(T) 6 ml/kg,压力上升时间设置为0.5 s;V组双肺通气期间设置V_(T) 8 ml/kg,OLV期间设置V_(T) 6 ml/kg,吸气暂停时间为0 s。记录术后1、2、3 d和出院前PPCs的发生情况。记录OLV前(T_(0))、OLV 30 min(T_(1))、OLV 60 min(T_(2))和OLV结束后(T_(3))的吸气峰压(PIP)、驱动压(ΔP)、动态肺顺应性(Cdyn)以及PaO_(2)、PaCO_(2)和氧合指数(PaO_(2)/FiO_(2))。结果术后1 d P组PPCs发生率明显低于V组[2例(9%)vs 8例(38%),P<0.05]。术后2、3 d和出院前两组PPCs发生率差异无统计学意义。T_(0)—T_(3)时P组PIP明显低于V组(P<0.05)。与T_(0)时比较,T_(1)、T_(2)时两组PIP和ΔP明显升高(P<0.05),Cdyn明显降低(P<0.05)。T_(0)—T_(3)时两组ΔP、Cdyn、PaO_(2)、PaCO_(2)和PaO_(2)/FiO_(2)差异无统计学意义。结论PCV-VG模式优于VCV模式,可明显减少肺切除患者术后1 d肺部并发症的发生,降低术中吸气峰压。Objective To observe the effect of pressure control ventilation with volume guarantee(PCV-VG)on postoperative pulmonary complications(PPCs)in patients undergoing pulmonary resection.Methods Forty-two patients scheduled for thoracoscopic lung resection surgery,19 males and 23 females,aged 18-65 years,ASA physical statusⅠorⅡ,were randomly allocated into group P(n=21)and group V(n=21)to receive PCV-VG or VCV mode,respectively.In group P,V_(T) was 8 ml/kg during two-lung ventilation while V_(T) was 6 ml/kg during OLV and the pressure slope time was 0.5 s.In group V,V_(T) was 8 ml/kg during two-lung ventilation while V_(T) 6 ml/kg during OLV and the inspiratory pause time was 0 s.The occurrence of PPCs was recorded 1,2,3 days after operation and before discharge.PIP,ΔP,Cdyn,PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)were recorded before OLV(T_(0)),OLV 30 min(T_(1)),OLV 60 min(T_(2))and after OLV(T_(3)).Results The incidence of PPCs in group P was significantly lower than that in group V 1 day after surgery[2 cases(9%)vs 8 cases(38%),P<0.05].There was no statistically significant difference in the incidence of PPCs between the two groups 2 and 3 days after operation and before discharge.PIP in group P was significantly lower than that in group V at T_(0)-T_(3)(P<0.05).Compared with T_(0),PIP andΔP of the two groups at T_(1)and T_(2)were significantly increased(P<0.05),and Cdyn was significantly decreased(P<0.05).There was no difference inΔP,Cdyn,PaO_(2),PaCO_(2)and PaO_(2)/FiO_(2)between the two groups at T_(0)-T_(3).Conclusion PCV-VG mode is superior to VCV mode because it can decline PPCs on the first day after surgery and can decline intraoperative PIP in patients undergoing pulmonary resection surgery.

关 键 词：术后肺部并发症 压力控制容量保证 吸气峰压 肺切除手术 

分 类 号：R614[医药卫生—麻醉学]