摘要
目的探讨肺保护性通气策略对胸腔镜下肺癌根治术患者的肺保护效应。方法择期在全身麻醉下行胸腔镜肺癌根治术患者96例,ASA分级Ⅰ或Ⅱ级,采用数字表法将患者随机分成3组,即常规通气组(CV组)、100%吸入氧浓度(FiO_2)保护性通气组(PV-Ⅰ组)、60%FiO_2保护性通气组(PV-Ⅱ组),每组32例。CV组V_T_10ml/kg,FiO_2100%; PV-Ⅰ组与PV-Ⅱ组,V_T_6ml/kg+PEEP 5cmH_2O+肺复张,PV-Ⅰ组FiO_2100%,PV-Ⅱ组FiO_260%。3组吸呼比1∶1. 5,氧流量1L/min,调节呼吸频率维持P_(ET)CO_2在35～45mmHg。于双肺通气10min(T_1)、单肺通气30min(T_2)、单肺通气60min(T_3)、再次改为双肺通气15min(T_4)、入ICU后1h(T_5)、术后24h(T_6)抽取桡动脉血行血气分析,计算氧合指数(PaO_2/FiO_2)。同时持续监测SpO_2、P_(ET)CO_2、MAP、气道峰压(P_(peak))、平台压(P_(plat)),计算T_(1～4)时肺静态顺应性(static lung compliance,Cs)。记录术后3天内肺部并发症的发生情况。记录引流管拔除时间及术后住院时间。结果与CV组比较,PV-Ⅰ组与PV-Ⅱ组T_2、T_3、T_5、T_6时PaO_2/FiO_2升高,T_(1～4)时P_(peak)、P_(plat)降低,T_2、T_3时Cs升高,差异有统计学意义(P <0. 05)。PV-Ⅰ组与PV-Ⅱ组在各时间点PaO_2/FiO_2、P_(peak)、P_(plat)和Cs比较,差异无统计学意义(P> 0. 05)。与CV组比较,PV-Ⅱ组术后3天内肺部并发症发生率降低(P <0. 017),CV组与PV-Ⅰ组、PV-Ⅰ组与PV-Ⅱ组术后3天内肺部并发症发生率比较,差异无统计学意义(P> 0. 017)。结论与常规通气策略比较,肺保护性通气策略能够改善胸腔镜下肺癌根治术患者氧合及肺顺应性,60%FiO_2肺保护性通气策略能够更有效减少术后肺部并发症的发生。
Objective To investigate the protective effects of lung protective ventilation on the lungs in patients undergoing thoraeoscopic radical resection of lung cancer.Methods A total of 96 patients,of ASA physical status Ⅰ or Ⅱ ,undergoing thoracoscopie radical resection of lung cancer,were randomly divided into three groups using a random number table (n =32for each group):conventional meehanial ventilation group (group CV),protective ventilation management group with 100% of FiO2(group PV -Ⅰ)and protective ventilation management group with 60% of FiO2(group PV -Ⅱ).The mechanical ventilation parameters in group CV consisted of FiO2 100%,tidal volume (VT)10ml/kg.The group PV -Ⅰ consisted of FiO 2100%,VT6mL/kg,PEEP 5cmH2O,and alveolar recruitment. The group PV-Ⅱ consisted of FiO2 60%,VT6ml/kg,PEEP 5cmH2O,and alveolar recruitment.The oxygen flow was IL/min,inspiratory/expiratory ratio 1:1.5,PETCO2was maintained at 35-45mmHg.At 10min of TLV(T1),at 30min of OLV (T2),at 60 min of OLV (T3),at 15min after restoration of TLV (T4),at lh in ICU (T5 )and at 24h after operation (T6),arterial blood was sampled to conduct the gas analysis,PaO2/FiO2 ratio was calculated.SpO2,PETCO2,MAP,peak pressure (Ppeak),and plateau pressure (Pplat)of the airway were monitored continuously.At T1-4,static lung compliance (Cs)were calculated.Pulmonary complications within postoperative three days were recorded.Results Compared with group CV,PaO2/FiO2 of group PV -Ⅰ and group PV -Ⅱ was significantly higher (T2,T3,T5,T6),Ppeak and Pplat,were lower (T1-4),and Cs was higher(T2,T3)(P <0.05).There were no significant differences between group PV -Ⅰ and group PV -Ⅱ in the PaO2/FiO2,Ppeak,Pplat and Cs.Compared with group CV,the incidence of postoperative pulmonary complications in group PV -Ⅱ was significantly reduced within 3 days after operation (P <0.017).Conclusion Compared with conventional ventilation strategy,protective ventilation strategy can improve oxygenation and lung compliance.Protective ventilation strategy with 60% of FiO2 can effectively reduce postoperative pulmonary complications.
作者
李晴晴
李亚鹏
刘苏
刘功俭
Li Q ingqing;Li Yapeng;Liu Su(Xuzhou Medical University,Jiangsu 221004,China)
出处
《医学研究杂志》
2018年第11期171-175,共5页
Journal of Medical Research
关键词
肺保护性通气
单肺通气
肺癌根治术
术后肺部并发症
Lung protective ventilation
One -lung ventilation
Radical resection of lung cancer
Postoperative pulmonary complications
作者简介
通讯作者:刘功俭,电子信箱:liugongjian61@hotmail.com
