压力调节容量控制通气模式在胸腔镜肺癌根治术患者中应用效果评价  

Evaluation of the effect of pressure-regulated volume-controlled ventilation mode in patients undergoing thoracoscopic radical resection of lung cancer

作　　者：陈宇[1] 周强[1] 张雷[2] 王二凯 刘轼 吴春梅 CHEN Yu;ZHOU Qiang;ZHANG Lei;WANG Erkai;LIU Shi;WU Chunmei(Department of Anesthesiology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui, China;Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui, China)

机构地区：[1]安徽医科大学附属宿州医院麻醉科,安徽宿州234000 [2]蚌埠医学院第一附属医院胸外科,安徽蚌埠233004

出　　处：《西部医学》2022年第7期1078-1082,1088,共6页Medical Journal of West China

基　　金：安徽省教育厅基金项目(KJ2019A0340);宿州市科技计划项目(202014)。

摘　　要：目的 探讨胸腔镜肺癌根治术中应用压力控制容量保证通气(PCV-VG)模式和容量控制通气(VCV)模式对患者肺功能的影响。方法 收集安徽医科大学附属宿州医院2019年1月~2021年2月拟行胸腔镜肺癌根治术患者共66例,采用随机数字表法分为PCV-VG组(观察组)和VCV组(对照组),每组33例。记录并计算两组患者侧卧位后15 min(T0)、单肺通气30 min(T1)、60 min(T2)、双肺通气恢复15 min(T3)的平均气道压力(Pmean)、气道峰压(Ppeak)、肺动态顺应性(Cdyn)。采集桡动脉血样,血气分析测肺泡氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))值,采用ELISA法测定血清肺泡表面活性物质-D(SP-D)、血管生成素-2(Ang-2)、白介素-6(IL-6)和肿瘤坏死因子(TNF-α)的浓度。于双肺通气恢复15 min后,完成肺超声评分(LUS)。结果 两组患者于T1、T2时,Ppeak及Pmean出现升高,Cdyn及PaO2下降,且对照组升高或下降的幅度更明显,与观察组相比差异有统计学意义(P<0.05)。而PaCO_(2)组间及组内比较,差异无统计学意义(P>0.05)。两组患者随着时间延长,SP-D、Ang-2、IL-6和TNF-α等指标均有升高,但对照组升高更明显,差异有统计学意义(P<0.05)。与对照组比较,观察组肺超声评分更低(10.2±2.3 vs 12.1±3.2),差异有统计学意义(P<0.05)。结论 与VCV比较,PCV-VG模式明显降低胸腔镜肺癌根治术患者的Ppeak及Pmean,改善肺顺应性及氧合,降低肺损伤相关细胞因子水平,从而减轻患者的肺损伤,且经肺超声评估证实。Objective To compare the effects of PCV-VG mode and VCV mode on lung function in patients with thoracoscopic radical resection of lung cancer.Methods A total of 66 patients with thoracoscopic radical resection of lung cancer from January 2019 to February 2021 in Suzhou Hospital Affiliated to Anhui Medical University were collected.They were divided into PCV-VG group(observation group)and VCV group(control group)by random number table method,with 33 cases in observation group and 33 cases in control group.The peak airway pressure(Ppeak),mean airway pressure(Pmean)and pulmonary dynamic compliance(Cdyn)were recorded and calculated at 15min after lateral decubitus(T0),30min after single lung ventilation(T1),60min after single lung ventilation(T2),and 15min after lung ventilation recovery(T3).The blood samples of radial artery were collected,and the values of PaO2 and PaCO_(2) were measured by blood gas analysis.The levels of SP-D,Ang-2,IL-6 and TNF-αin serum were measured by ELISA.After recovery of bilateral lung ventilation for 15 min,the lung ultrasound score(LUS)was performed.Results At the time points of T1 and T2,the values of Ppeak and Pmean increased,the values of Cdyn and PaO_(2) decreased between these two groups,and the increasing or decreasing range of control group was more significant than observation group(P<0.05).There was no significant difference in PaCO_(2) between the two groups(P>0.05).With the prolongation of time in the two groups,the levels of SP-D,Ang-2,IL-6 and TNF-αwere all increased,but the degree of increase was more obvious in control group,and the difference between the two groups was statistically significant(P<0.05).Compared with control group,LUS in observation group was lower(10.2±2.3 and 12.1±3.2,respectively),and the difference between the two groups was statistically significant(P<0.05).Conclusion Compared with VCV,PCV-VG can significantly reduce the Ppeak and Pmean of patients undergoing thoracoscopic radical resection of lung cancer,improve pulmonary compliance and oxygenati

关 键 词：压力控制容量保证通气 容量控制通气 胸腔镜肺癌根治术 肺功能 炎症反应 肺超声评分 

分 类 号：R734.2[医药卫生—肿瘤]