通气模式对胸腔镜肺切除术患者术后肺部并发症影响的回顾性队列研究  

Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study

作　　者：金亮 玉红[1] 毛文杰[1,3] 孙琪荣 田伟[1] 余海 JIN Liang;YU Hong;MAO Wenjie;SUN Qirong;TIAN Wei;YU Hai(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Anesthesiology,Leshan People's Hospital,Leshan,614000,Sichuan,P.R.China;Department of Anesthesiology,Jianyang People's Hospital,Chengdu,641400,P.R.China)

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]乐山市人民医院麻醉科,四川乐山614000 [3]简阳市人民医院麻醉科,成都641400

出　　处：《中国胸心血管外科临床杂志》2022年第2期211-218,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨压力控制-容量保证通气(pressure-controlled ventilation-volume guaranteed,PCV-VG模式与容量控制通气(volume-controlled ventilation,VCV)模式对胸腔镜肺切除术患者术后肺部并发症的影响。方法回顾性分析2020年9月—2021年3月在四川大学华西医院行择期胸腔镜肺手术329例患者的临床资料,其中女213例、男116例,平均年龄(53.6±11.3)岁。美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅲ级。纳入患者麻醉期间均采用肺保护性通气策略,根据通气模式将其分为PCV-VG组(PCVVG模式,165例)和VCV组(VCV模式,164例)。主要结局指标为住院期间肺部并发症发生率。结果术后住院期间共有73例(22.2%)患者发生了肺部并发症,PCV-VG组发生率为21.8%,VCV组发生率为22.6%[RR=0.985,95%CI(0.569,1.611),P=0.871]。多因素logistic回归分析显示PCV-VG与VCV模式相比,住院期间术后肺部并发症发生率差异无统计学意义[OR=0.846,95%CI(0.487,1.470),P=0.553]。结论对于胸腔镜肺手术患者,通气模式的选择与住院期间术后肺部并发症的发生风险不相关。Objective To evaluate the association between pressure-controlled ventilation-volume guaranteed(PCV-VG)mode and volume-controlled ventilation(VCV)mode on postoperative pulmonary complications(PPCs)in patients undergoing thoracoscopic lung resection.Methods A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March2021 was conducted,including 213 females and 116 males,aged 53.6±11.3 years.American Society of Anesthesiologists(ASA)grade wasⅠ-Ⅲ.The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group(n=165)and a VCV group(n=164)according to intraoperative ventilation mode.Primary outcome was the incidence of PPCs during hospitalization.Results A total of 73(22.2%)patients developed PPCs during hospitalization.The PPCs incidence of PCV-VG and VCV was 21.8%and 22.6%,respectively(RR=0.985,95%CI 0.569-1.611,P=0.871).Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization(OR=0.846,95%CI 0.487-1.470,P=0.553).Conclusion Among patients undergoing thoracoscopic lung resection,intraoperative ventilation mode(PCV-VG or VCV)is not associated with the risk of PPCs during hospitalization.

关 键 词：通气模式 胸腔镜肺切除术 术后肺部并发症 单肺通气 

分 类 号：R655.3[医药卫生—外科学]