压力控制容量保证通气对尘肺病全肺灌洗患者呼吸功能的影响  

Effect of pressure-controlled ventilation-volume guaranteed model on respiratory function in pneumoconiosis patients undergoing whole-lung lavage

作　　者：刘超[1] 陈育全[1] 赵亚娟[1] 敖正 熊璐 孙玉琦[1] LIU Chao;CHEN Yuquan;ZHAO Yajuan;AO Zheng;XIONG Lu;SUN Yuqi(Guangzhou Twelfth People’s Hospital,Guangzhou Occupational Disease Prevention and Treatment Hospital,Guangzhou,Guangdong 510620,China)

机构地区：[1]广州市第十二人民医院(广州市职业病防治院),广东广州510620

出　　处：《职业卫生与应急救援》2025年第1期41-45,共5页Occupational Health and Emergency Rescue

基　　金：广东省医学科学技术研究基金项目(A2017600);广州市科学技术局基础与应用基础研究项目(SL2023A03J00736)。

摘　　要：目的评价尘肺病全肺灌洗患者采用压力控制容量保证通气(pressure-controlled ventilation-volume guaranteed,PCV-VG)模式对患者呼吸功能的影响。方法选择2019年9月—2023年9月行全肺灌洗(whole-lung lavage,WLL)的尘肺病患者为研究对象,根据当时治疗时采用的通气方式不同分为两组:PCV-VG组和容量控制通气(volumecontrolled ventilation,VCV)模式组,采用随机数字表法每组抽取30例。两组患者分别在单肺PCV-VG、VCV模式机械通气下实施全肺灌洗并复苏。采集患者入院后(T_(0))、灌洗前(T_(1))、灌洗结束(T_(2))、复苏早期30 min(T_(3))、复苏后期60 min(T_(4))、术后第1个24 h(T_(5))、术后第二个24 h(T_(6))、术后第3个24 h(T7)的桡动脉血血气分析结果,包括氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、肺泡-动脉氧分压差(PA-aDO_(2))、乳酸(LAC)水平,以及T_(1)、T_(2)、T_(3)、T_(4)阶段的气道峰压(Ppeak)、气道平台压(Pplat)、动态肺顺应性(Cldyn)及驱动压(DP)等数据,分析比较各指标的差异。结果两组患者在年龄、体质量指数、尘肺病分期方面差异均无统计学意义(P>0.05)。PCV-VG组与VCV组各指标在各时间点比较的结果如下:在T_(1)时间点,两组血气分析各指标差异均无统计学意义(P>0.05);在T_(2)时间点,PCV-VG组PaCO_(2)低于VCV组(均P<0.05);T_(3)时间点,PCV-VG组PaO_(2)高于VCV组,PaCO_(2)低于VCV组(均P<0.05);T_(4)时间点,PCV-VG组PaO_(2)高于VCV组,PaCO_(2)、PA-aDO_(2)、LAC低于VCV组(均P<0.05);T_(6)时间点,PCV-VG组PA-aDO_(2)、LAC低于VCV组(均P<0.05);T7时间点,PCV-VG组PaCO_(2)低于VCV组(P<0.05)。在T_(1)时间点,两组呼吸力学各项参数指标差异均无统计学意义(P>0.05);在T_(2)、T_(3)、T_(4)时间点,PCV-VG组Ppeak、Pplat较低(P<0.01),Cldyn较高(P<0.05);在T_(3)时间点,PCV-VG组DP较低(P<0.01)。结论与VCV模式比较,PCV-VG模式可以降低患者气道压力和呼吸机驱动压,提高肺顺应性,维持良好的氧供应,有利于�Objective To explore the effect of pressure-controlled ventilation-volume guaranteed(PCV-VG)mode on the respiratory function of patients undergoing whole-lung lavage(WLL)for pneumoconiosis.Methods Pneumoconiosis patients who underwent WLL from September 2019 to September 2023 were divided into two groups according to the ventilation mode used during original treatment,the PCV-VG or the volume-controlled ventilation(VCV),with a total of 30 patients in each group randomly selected by random number table method.Patients in the two groups were subjected to whole-lung lavage and resuscitated under one-lung PCV-VG and VCV mode mechanical ventilation,respectively.Their medical records of radial artery blood gas analysis,including partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),alveolar-arterial oxygen pressure difference(PA-aDO_(2)),and lactate(LAC),were collected at admission(T_(0)),before lavage(T_(1)),at the end of lavage(T_(2)),30 minutes after early resuscitation(T_(3)),60 minutes after late resuscitation(T_(4)),24 hours post-operation(T_(5)),48 hours post-operation(T_(6)),and 72 hours post-operation(T7).Additionally,the indicators of respiratory function,such as peak airway pressure(Ppeak),plateau pressure(Pplat),dynamic lung compliance(Cldyn),and driving pressure(DP),were recorded at T_(1),T_(2),T_(3),and T_(4) points in time.The differences of each observation index were analyzed and compared.Results There were no statistically significant differences between the two groups in terms of age,BMI,and pneumoconiosis stage(all P>0.05).Comparison of blood gas analysis results between the PCV-VG group and the VCV group:at T_(1),no statistically significant differences(P>0.05);at T_(2),PaCO_(2) was lower in the PCV-VG group than in the VCV group(P<0.05);at T_(3),PaO_(2) was higher,and PaCO_(2) was lower in the PCV-VG group than in the VCV group(both P<0.05);at T_(4),PaO_(2) was higher,and PaCO_(2),PA-aDO_(2),and LAC were lower in the PCV-VG group(all P<0.05);at T_(6),PA-aDO_(2) and LAC w

关 键 词：尘肺病 全肺灌洗 压力控制容量保证通气 容量控制通气 呼吸力学 呼吸功能 

分 类 号：R135.2[医药卫生—劳动卫生] R195[医药卫生—公共卫生与预防医学]