压力控制容量保证通气模式对肺切除术患者术后肺部并发症的影响

Effect of pressure control ventilation with volume guarantee mode on postoperative pulmonary complications in patients undergoing pulmonary resection

中文关键词: 术后肺部并发症  压力控制容量保证  吸气峰压  肺切除手术

英文关键词: Postoperative pulmonary complications  Pressure control ventilation with volume guarantee  Peak inspiratory pressure  Pulmonary resection

中文摘要:

      
目的 观察压力控制容量保证（PCV-VG）通气模式对肺切除术患者术后肺部并发症（PPCs）的影响。
方法 选择择期全麻下行胸腔镜肺切除术患者42例，男19例，女23例，年龄18～65岁，ASA Ⅰ或Ⅱ级。将患者随机分为两组：自双肺通气开始至手术结束始终使用PCV-VG模式通气组（P组）和始终使用容量控制通气(VCV)模式通气组（V组）,每组21例。P组双肺通气期间V_T 8 ml/kg，单肺通气（OLV）期间V_T 6 ml/kg，压力上升时间设置为0.5 s；V组双肺通气期间设置V_T 8 ml/kg，OLV期间设置V_T 6 ml/kg，吸气暂停时间为0 s。记录术后1、2、3 d和出院前PPCs的发生情况。记录OLV前（T0）、OLV 30 min（T1）、OLV 60 min（T2）和OLV结束后（T3）的吸气峰压（PIP）、驱动压（ΔP）、动态肺顺应性（Cdyn）以及PaO₂、PaCO₂和氧合指数（PaO₂/FiO₂）。
结果 术后1 d P组PPCs发生率明显低于V组［2例（9%） vs 8例（38%），P<0.05］。术后2、3 d和出院前两组PPCs发生率差异无统计学意义。T0—T3时P组PIP明显低于V组（P<0.05）。与T0时比较，T1、T2时两组PIP和ΔP明显升高（P<0.05），Cdyn明显降低（P<0.05）。T0—T3时两组ΔP、Cdyn、PaO₂、PaCO₂和PaO₂/FiO₂差异无统计学意义。
结论 PCV-VG模式优于VCV模式，可明显减少肺切除患者术后1 d肺部并发症的发生，降低术中吸气峰压。

英文摘要:

      
Objective To observe the effect of pressure control ventilation with volume guarantee (PCV-VG) on postoperative pulmonary complications (PPCs) in patients undergoing pulmonary resection.
Methods Forty two patients scheduled for thoracoscopic lung resection surgery, 19 males and 23 females, aged 18-65 years, ASA physical status Ⅰ or Ⅱ, were randomly allocated into group P (n = 21) and group V (n = 21) to receive PCV-VG or VCV mode, respectively. In group P, V_T was 8 ml/kg during two lung ventilation while V_T was 6 ml/kg during OLV and the pressure slope time was 0.5 s. In group V, V_T was 8 ml/kg during two lung ventilation while V_T6 ml/kg during OLV and the inspiratory pause time was 0 s. The occurrence of PPCs was recorded 1, 2, 3 days after operation and before discharge. PIP, ΔP, Cdyn, PaO₂, PaCO₂, and PaO₂/FiO₂ were recorded before OLV (T0), OLV 30 min (T1), OLV 60 min (T2) and after OLV (T3).
Results The incidence of PPCs in group P was significantly lower than that in group V 1 day after surgery [2 cases (9%) vs 8 cases (38%), P < 0.05]. There was no statistically significant difference in the incidence of PPCs between the two groups 2 and 3 days after operation and before discharge. PIP in group P was significantly lower than that in group V at T0-T3(P < 0.05). Compared with T0, PIP and ΔP of the two groups at T1 and T2 were significantly increased (P < 0.05), and Cdyn was significantly decreased (P < 0.05). There was no difference in ΔP, Cdyn, PaO₂, PaCO₂ and PaO₂/FiO₂ between the two groups at T0-T3.
Conclusion PCV-VG mode is superior to VCV mode because it can decline PPCs on the first day after surgery and can decline intraoperative PIP in patients undergoing pulmonary resection surgery.