摘要
目的评价压力控制容量保证通气（PCV-VG）用于胸腔镜单肺通气患者肺保护性通气的效果。方法择期全麻下胸腔镜食管癌根治术患者60例，年龄50～70岁，BMI 18～26 kg/m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n＝30）：容量控制通气组（V组）和PCV-VG组（P组）。双肺通气时VT 10 ml/kg，RR 10～12次/min；单肺通气时VT 6 ml/kg，RR 12～16次/min，I∶E 1∶2，压力限制设定为35 cmH2O，吸入氧浓度为60%，流量2 L/min，维持PETCO2 35～40 mmHg。维持术后VAS评分≤3分。于入室后（T0）、术后1 d（T1）、3 d（T2）及7 d（T3）时测定用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、最大呼气中段流量（MMEF），并行血气分析，记录PaCO2、PaO2，计算肺泡-动脉血氧分差（PA-aO2）；T1、T2及T3时行临床肺部感染评分；记录胸部引流管拔除时间以及术后住院时间。结果与T0时比较，T1～T3时2组FVC、FEV1、MMEF和PaO2降低，PA-aO2升高（P〈0.05）；与V组比较，P组T1～T3时FVC、FEV1、MMEF和PaO2升高，PA-aO2和临床肺部感染评分降低，胸部引流管拔除时间及术后住院时间缩短（P〈0.05）。结论PCV-VG对胸腔镜单肺通气患者可产生肺保护性通气效果，有助于改善预后。
Objective To evaluate the efficacy of pressure-controlled volume-guaranteed （PCV- VG） mode for lung protective ventilation in patients requiring one-lung ventilation （OLV） during thoracoscopic surgery. Methods Sixty patients, aged 50-70 yr, with body mass index of 18-26 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective radical resection of esophageal cancer performed via video-assisted thoracoscope under general anesthesia, were divided into 2 groups （n= 30 each） using a random number table： volume-controlled ventilation group （group V） and PCV-VG group （group P）. The ventilator settings were adjusted, with a tidal volume 10 ml/kg and respiratory rate 10-12 breaths/min during two-lung ventilation, and with a tidal volume 6 ml/kg and respiratory rate 12-16 breaths/min during OLV. The inspiratory/expiratory ratio was 1 ： 2, pressure restriction was 35 cmH20, and 33% oxygen was inhaled at 2 L/min. The end-tidal pressure of carbon dioxide was maintained at 35-40 mmHg. Visual analog scale score was maintained ≤ 3 after operation. After admission to the operation room （T0） and at 1, 3 and 7 days after operation （ T1-3 ） , forced vital capacity （FVC） , forced expiratory volume in first second （FEV1）, and maximal mid-expiratory flow （MMEF） were measured, arterial blood samples were collected for blood gas analysis, arterial carbon dioxide partial pressure and arterial oxygen partial pressure （PaO2） were recorded, and alveolar-arterial oxygen tension difference （PA-aO2） was calculated. Clinical Pulmonary Infection Score was assessed at T1, T2 and T3. The chest tube removal time and length of postoperative hospital stay were recorded. Results Compared with the baseline at T0,FVC, FEV1, MMEF and PaO2 were significantly decreased, and PA-O2 was increased at T1.3 in the two groups （P〈0.05）. Compared with group V, FVC, FEV1 , MMEF and PaO2 were significantly increased, PA-O2 and Clinical Pulmonary Infection Score were
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2017年第2期155-158,共4页
Chinese Journal of Anesthesiology
关键词
呼吸
人工
胸腔镜检查
Respiration,artificial
Thoracoscopy
