驱动压指导肺保护性通气策略联合压力控制通气对胸腔镜下肺癌根治术老年患者的肺保护作用  

Lung protective effect of driving pressure⁃guided lung protective ventilation strategy combined with pressure⁃controlled ventilation in elderly patients undergoing thoracoscopic radical resection of lung cancer

作　　者：吴慧敏 赵娟[1] 刘毅[2] 李国华[2] 白日虹[2] 任强 Wu Huimin;Zhao Juan;Liu Yi;Li Guohua;Bai Rihong;Ren Qiang(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Department of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]山西省肿瘤医院中国医学科学院肿瘤医院山西医院山西医科大学附属肿瘤医院麻醉科,太原030013 [3]山西医科大学第二医院麻醉科,太原030001

出　　处：《肿瘤研究与临床》2022年第12期881-885,共5页Cancer Research and Clinic

摘　　要：目的探讨驱动压指导肺保护性通气策略(LPVS)联合压力控制通气(PCV)对胸腔镜下肺癌根治术老年患者的肺保护作用。方法选择山西医科大学第二医院2021年4月至2022年4月择期在胸腔镜下行肺癌根治术的老年患者100例,年龄60~80岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级。采用随机数字表法将所有患者分为4组,每组25例。A组采用容量控制通气(VCV)+固定5 cm H_(2)O(1 cm H_(2)O=0.098 kPa)呼气末正压(PEEP),B组采用PCV+固定5 cm H_(2)O PEEP,C组采用VCV+驱动压指导个体化PEEP,D组采用PCV+驱动压指导个体化PEEP。记录单肺通气(OLV)通气前(T_(0))、OLV开始后30 min(T_(1))及OLV开始后60 min(T_(2))的动脉氧分压(PaO_(2))等。于T_(0)时刻和恢复双肺通气后10 min(T_(3))时刻检测患者桡动脉血样血浆中性粒细胞弹性蛋白酶(NE)浓度。记录术后5 d内肺部并发症(PPC)发生情况。结果A、B组T_(1)时刻PaO_(2)[(135±50)、(146±51)mmHg(1 mmHg=0.133 kPa)]和T_(2)时刻PaO_(2)[(137±46)、(143±47)mmHg]均低于C、D组T_(1)时刻PaO_(2)[(168±27)、(190±30)mmHg]和T_(2)时刻PaO_(2)[(180±30)、(183±24)mmHg](均P<0.05)。A组术后5 d内PPC发生率高于D组[36%(9/25)比4%(1/25)],差异有统计学意义(P=0.005)。A组T_(3)时刻NE浓度[(202.8±9.7)ng/ml]高于B、C、D组[(182.5±12.0)、(180.0±10.3)、(160.6±13.0)ng/ml](P<0.05)。结论OLV期间,驱动压指导LPVS联合PCV在改善氧合、减轻炎症方面表现出了明显的优势,对于胸腔镜下肺癌根治术的老年患者,驱动压指导LPVS联合PCV是一种安全有效的术中通气方式。Objective To investigate the lung protective effect of driving pressure‑guided lung protective ventilation strategy(LPVS)combined with pressure‑controlled ventilation(PCV)in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods One hundred elderly patients scheduled for thoracoscopic radical resection of lung cancer from April 2021 to April 2022 in the Second Hospital of Shanxi Medical University were selected.Patients were aged 60-80 years old and American Society of Anesthesiologists(ASA)classificationⅠ-Ⅱ.All patients were divided into 4 groups by using the random number table method,with 25 cases in each group.Group A received volume‑controlled ventilation(VCV)+5 cm H_(2)O(1 cm H_(2)O=0.098 kPa)PEEP,group B received PCV+5 cm H_(2)O PEEP,group C received VCV+driving pressure‑guided individualized PEEP,and group D received PCV+driving pressure‑guided individualized PEEP.The arterial oxygen partial pressure(PaO2)was recorded before one‑lung ventilation(OLV)(T_(0)),30 min after OLV(T_(1))and 60 min after OLV(T_(2)).The serum concentrations of neutrophil elastase(NE)in radial artery blood samples of patients were measured at T_(0) and 10 min after the end of OLV(T_(3)).The occurrence of postoperative pulmonary complications(PPC)within 5 d after surgery was recorded.Results The PaO2 of group A and B at T_(1)[(135±50),(146±51)mmHg(1 mmHg=0.133 kPa)]and T_(2)[(137±46),(143±47)mmHg]were lower than those of group C and group D at T_(1)[(168±27),(190±30)mmHg]and T_(2)[(180±30),(183±24)mmHg](all P<0.05).The incidence of PPC within 5 d after surgery in group A was higher than that in group D[36%(9/25)vs.4%(1/25)](P=0.005).The concentration of NE at T_(3) in group A[(202.8±9.7)ng/ml]was lower than that in group B,C and D[(182.5±12.0),(180.0±10.3),(160.6±13.0)ng/ml](P<0.05).Conclusions During OLV,driving pressure‑guided LPVS combined with PCV can not only improve oxygenation,but also show obvious advantages in reducing inflammatory response.It is a safe and effective

关 键 词：肺肿瘤 老年人 单肺通气 驱动压 

分 类 号：R734.2[医药卫生—肿瘤] R614[医药卫生—临床医学]