压力控制容量保证通气对胸腔镜肺叶切除术患者围术期肺功能的影响  

Effect of pressure⁃controlled volume⁃guaranteed ventilation on perioperative pulmonary function in patients undergoing thoracoscopic lobectomy

作　　者：张建友 郭宁 杨大威 王溢鑫 唐苏红 段鲜宁 ZHANG Jianyou;GUO Ning;YANG Dawei;WANGYixin;TANG Suhong;DUAN Xianning(Department of Anesthesia,Affiliated Hospital of Yangzhou Uni-versity,225000 Yangzhou,China)

机构地区：[1]扬州大学附属医院麻醉科,225000

出　　处：《临床麻醉学杂志》2024年第8期820-824,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察压力控制容量保证通气(PCV-VG)对胸腔镜手术患者术中呼吸力学、肺损伤标志物和术后肺部并发症(PPCs)的影响。方法选择择期全麻下胸腔镜肺叶切除术患者59例,男29例,女30例,年龄18~64岁,BMI 18.5~26.0 kg/m ^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:PCV-VG组(P组,n=29)和容量控制通气(VCV)组(V组,n=30)。P组单肺通气(OLV)时使用PCV-VG模式,V组使用VCV模式,所有患者麻醉诱导和维持药物一致。记录麻醉诱导前、插管后5 min、OLV后15 min、30 min、术后3 d的PaO_(2),计算氧合指数(OI)、肺内分流率(Qs/Qt)。记录插管后5 min、OLV后15 min、30 min的气道峰压(Ppeak)、肺动态顺应性(Cdyn)、驱动压(DP)。在麻醉诱导前、拔管后测定Clara细胞分泌蛋白-16(CC-16)和白细胞介素-6(IL-6)浓度。记录术后1周内PPCs发生情况。结果与V组比较,OLV后15 min、30 min P组Ppeak和DP明显降低,Cdyn明显升高(P<0.05),术后3 d P组PaO_(2)和OI明显升高(P<0.05),拔管后P组CC-16和IL-6浓度明显降低(P<0.05),术后1周内PPCs发生率明显降低(P<0.05)。结论在胸腔镜手术单肺通气期间,压力控制容量保证通气可降低气道峰压和驱动压,增加肺动态顺应性,改善氧合,降低术后肺部并发症发生率。Objective To observe the effect of pressure-controlled ventilation volume-guaranteed(PCV-VG)mode on respiratory mechanics,lung injury markers and postoperative pulmonary complications(PPCs)in thoracoscopic patients.Methods Fifty-nine patients undergoing elective thoracoscopic lobectomy,29 males and 30 females,aged 18-64 years,BMI 18.5-26.0 kg/m ^(2),ASA physical statusⅠorⅡ,were divided into two groups using a random number table method:the PCV-VG mode group(group P,n=29)and the volume-controlled ventilation(VCV)mode group(group V,n=30).The PCV-VG mode was used for one-lung ventilation(OLV)in group P,and the VCV mode was used in group V.Anesthesia induction and maintenance medications were consistent in all patients.PaO_(2) was recorded before induction of anesthesia,5 minutes after intubation,15 minutes after OLV,30 minutes after OLV,and 3 days postoperatively,and oxygenation index(OI)and intrapulmonary shunt rate(Qs/Qt)were calculated.Peak airway pressure(Ppeak),pulmonary dynamic compliance(Cdyn),and driving pressure(DP)were recorded 5 minutes after intubation,15 minutes after OLV,and 30 minutes after OLV.Clara cell secretory protein-16(CC-16)and interleukin-6(IL-6)concentration were measured before induction of anesthesia and after extubation.Recording the occurrence of PPCs within 1 week after surgery.Results Compared with group V,Ppeak and DP were significantly reduced,Cdyn was increased significantly in group P 15 minutes and 30 minutes after OLV(P<0.05),PaO_(2) and OI were significantly increased in group P 3 days postoperatively(P<0.05),CC-16 and IL-6 concentrations were significantly reduced in group P after extubation(P<0.05).Compared with group V,the incidence of PPCs was significantly reduced in group P(P<0.05).Conclusion During one-lung ventilation for thoracoscopic surgery,the pressure-controlled ventilation volume-guaranteed mode reduces peak airway pressure and driving pressure,improves pulmonary dynamic compliance and improves oxygenation,reduces the incidence of PPCs.

关 键 词：单肺通气 压力控制容量保证通气 容量控制通气 胸腔镜手术 肺部并发症 

分 类 号：R614[医药卫生—麻醉学]