压力控制-容量保证通气模式下驱动压导向肺保护性通气策略对胸腹腔镜联合食管癌根治术患者的肺保护作用  

Lung protective effect of driving pressure-guided lung protective ventilation strategy under PCV-VG mode in patients undergoing thoracoscopic and laparoscopic radical esophagectomy

作　　者：马玉[1] 张林[1] 常家琦 王丽君[2] 卞清明[2] Ma Yu;Zhang Lin;Chang Jiaqi;Wang Lijun;Bian Qingming(Nanjing Medical University,Nanjing,Jiangsu 211166,China;Department of Anesthesiology,the Affiliated Cancer Hospital of Nanjing Medical University(Jiangsu Cancer Hospital),Nanjing,Jiangsu 210009,China)

机构地区：[1]南京医科大学,江苏南京211166 [2]南京医科大学附属肿瘤医院(江苏省肿瘤医院)麻醉科,江苏南京210009

出　　处：《中国内镜杂志》2025年第4期56-64,共9页China Journal of Endoscopy

摘　　要：目的 探讨压力控制-容量保证通气(PCV-VG)模式联合驱动压(PD)导向肺保护性通气策略对行胸腹腔镜联合食管癌根治术患者的肺保护作用。方法 选取2023年5月-2024年3月于该院择期行胸腹腔镜联合食管癌根治术的患者70例,采用随机数表法分为常规肺保护性通气策略组(C组)和PCV-VG模式下DP导向肺保护性通气策略组(P组),各35例。比较两组患者气管插管后5min(T_(1))、气腹建立后30min(T_(2))、单肺通气(OLV)前即刻(T_(3))、OLV后30min(T_(4))、OLV后60min(T_(5))和恢复双肺通气(TLV)后15min(T_(6))的气道峰压(Ppeak)、平台压(Pplat)、动态顺应性(Cdyn)和DP。记录两组患者麻醉诱导前(T_(0))、T_(2)、T_(3)、T_(4)、T_(5)和T_(6)时点的血压(BP)、心率(HR)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和pH值,以及两组患者术后肺部并发症(PPCs)的发生情况。结果与C组比较,P组T_(1)、T_(2)、T_(4)、T_(5)和T_(6)时点的Ppeak明显降低,Cdyn明显升高,差异均有统计学意义(P<0.05)。P组T_(1)、T_(4)、T_(5)和T_(6)时点的DP明显低于C组,T_(6)时点的Pplat明显低于C组,差异均有统计学意义(P<0.05);P组T_(4)和T_(5)时点的PaO_(2)明显高于C组,T_(6)时点的PaCO_(2)明显高于C组,差异均有统计学意义(P<0.05);两组患者T_(0)、T_(2)、T_(3)、T_(4)和T_(5)时点的PaCO_(2)比较,差异均无统计学意义(P>0.05)。两组患者各时点pH值比较,差异均无统计学意义(P>0.05)。P组在T_(4)时点的收缩压(SBP)明显高于C组,T_(6)时点的舒张压(DBP)明显低于C组,差异均有统计学意义(P<0.05);两组患者T_(0)、T_(2)、T_(3)和T_(5)时点SBP和DBP比较,以及各时点HR比较,差异均无统计学意义(P>0.05)。两组患者术后7d内PPCs发生率比较,差异无统计学意义(P>0.05)。结论 PCV-VG模式下DP导向肺保护性通气策略能够改善胸腹腔镜联合食管癌根治术患者术中的呼吸力学,提高OLV期间的氧合,且不会增加术后7d内PPCs发生Objective To explore the lung protective effect of pressure controlled ventilation-volume guaranteed(PCV-VG)combined with driving pressure(DP)guided lung protective ventilation strategy in patients undergoing thoracoscopic and laparoscopic radical esophagectomy.Methods 70 patients scheduled for elective thoracoscopic and laparoscopic radical esophagectomy were allocated into two groups using a random number table method:Conventional lung protective ventilation strategy group(group C)and DP guided lung protective ventilation strategy under PCV-VG mode group(group P),35 case in each group.Peak airway pressure(Ppeak),plateau pressure(Pplat),dynamic compliance(Cdyn)and DP were compared between the two groups at 5 minutes after intubation(T_(1)),30 min after pneumoperitoneum established(T_(2)),just prior to one lung ventilation(OLV)(T_(3)),30 min after OLV(T_(4)),60 min after OLV(T_(5))and 15 min from recovery of two lung ventilation(TLV)(T_(6)).The blood pressure(BP),heart rate(HR),arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide in arterial blood(PaCO_(2))and pH were recorded before anesthesia(T_(0)),T_(2),T_(3),T_(4),T_(5) and T_(6) time points.The occurrence of postoperative pulmonary complications(PPCs)also recorded.Results Compared with group C,Ppeak in group P at T_(1),T_(2),T_(4),T_(5) and T_(6) time points was significantly decreased,and Cdyn was obviously increased,the differences were statistically significant(P<0.05).At the T_(1),T_(4),T_(5) and T_(6) time points,the DP was lower in group P compared to group C,and Pplat at T_(6) time point was lower than that in group C,the differences were statistically significant(P<0.05).At the time points of T_(4) and T_(5),the PaO_(2) in group P was higher than that in Group C,and the PaCO_(2) at T_(6) time point was also higher than that in group C,the differences were statistically significant(P<0.05).The comparison of PaCO_(2) at T_(0),T_(2),T_(3),T_(4) and T_(5) time points of the two groups,the difference was not statistically signi

关 键 词：驱动压 呼气末正压(PEEP) 压力控制-容量保证通气(PCV-VG)模式 呼吸力学 食管癌根治术 

分 类 号：R735.1[医药卫生—肿瘤]