中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
13期
1006-1009
,共4页
胡序凯%沈华春%李晓瑜%陈骏萍
鬍序凱%瀋華春%李曉瑜%陳駿萍
호서개%침화춘%리효유%진준평
单肺通气%肺损伤%肺功能%通气模式
單肺通氣%肺損傷%肺功能%通氣模式
단폐통기%폐손상%폐공능%통기모식
One-lung ventilation%Lung injury%Pulmonary function%Ventilation mode
目的 在单肺通气期间比较容量控制通气模式(VCV)和压力控制容量保证通气模式(PCV-VG)对循环、肺功能和肺损伤的影响.方法 2012年2月至2013年3月在宁波市第二医院心胸外科择期行胸腔镜下肺叶切除30例患者,年龄52 ～ 76岁,美国麻醉医师协会(ASA)Ⅱ～Ⅲ级,随机分成VCV组和PCV-VG组(每组15例),麻醉诱导气管插管后插入支气管封堵导管,行健侧单肺通气,分别于侧卧位后15 min(T0)、OLV后15 min(T1)、OLV后60 min(T2)和恢复双肺通气后15 min(T3)记录心率(HR)、平均动脉压(MAP)、实测潮气量(TV)、气道峰压(Ppeak)、气道阻力(Raw)、胸肺顺应性(Cdyn)和呼末二氧化碳分压(PETCO2),同时抽取动脉血行血气分析,检测pH值、血氧分压(PaO2)和血二氧化碳分压(PaCO2)等指标;在麻醉前(T0)、OLV后1 h(T1)和手术结束后1 h(T2),用酶联免疫吸附法(ELISA)测定肿瘤坏死因子(TNFα),白细胞介素6(IL-6)的浓度.结果 侧卧位后15 min(T0)、OLV后15 min(T1)、OLV后60 min(T2)和恢复双肺通气后15 minVCV组和PCV-VG组心率、MAP、TV、PETCO2、pH值和PaCO2组间差异均无统计学意义(均P＞0.05),侧卧位后15 min(T0)和恢复双肺通气后15 min VCV组和PCV-VG组的Ppeak分别为(16±3)、(16±3)cmH2O和(14 ±2)、(14 ±2)cmH2O,Cdyn分别为(43.5±5.9)、(43.8±6.7)ml/cmH2O和(49.7±7.1)、(53.3±9.6)ml/cmH2O组间差异均有统计学意义(均P＜0.05),在OLV后15 min、OLV后60 minPCV-VG组的Ppeak分别为(17±2)、(18±3)cmH2O显著低于VCV组(22±4)、(23±3)cmH2O,PCV-VG组的Cdyn分别为(38.6±6.3)、(37.3±6.0) ml/cmH2O显著高于于VCV组(29.6±3.2)、(30.3±3.8) ml/cmH2O组间差异均有统计学意义(均P＜0.01),OLV后1h和手术后1 h PCV-VG组的IL-6分别为(52.32±3.59)、(63.57±4.98) pg/ml显著低于VCV组的(62.65±4.17)、(82.38±4.10) pg/ml,PCV-VG组的TNFα分别为(3.23±0.27)、(4.01±0.28) pg/ml显著低于VCV组的(4.19±0.38)、(5.49 ±0.31) pg/ml组间差异均有统计学意义(均P＜0.01).结论 在胸腔镜下肺叶切除手术单肺通气中,PCV-VG模式较VCV模式在肺功能和肺保护方面具有更高的优势.
目的 在單肺通氣期間比較容量控製通氣模式(VCV)和壓力控製容量保證通氣模式(PCV-VG)對循環、肺功能和肺損傷的影響.方法 2012年2月至2013年3月在寧波市第二醫院心胸外科擇期行胸腔鏡下肺葉切除30例患者,年齡52 ～ 76歲,美國痳醉醫師協會(ASA)Ⅱ～Ⅲ級,隨機分成VCV組和PCV-VG組(每組15例),痳醉誘導氣管插管後插入支氣管封堵導管,行健側單肺通氣,分彆于側臥位後15 min(T0)、OLV後15 min(T1)、OLV後60 min(T2)和恢複雙肺通氣後15 min(T3)記錄心率(HR)、平均動脈壓(MAP)、實測潮氣量(TV)、氣道峰壓(Ppeak)、氣道阻力(Raw)、胸肺順應性(Cdyn)和呼末二氧化碳分壓(PETCO2),同時抽取動脈血行血氣分析,檢測pH值、血氧分壓(PaO2)和血二氧化碳分壓(PaCO2)等指標;在痳醉前(T0)、OLV後1 h(T1)和手術結束後1 h(T2),用酶聯免疫吸附法(ELISA)測定腫瘤壞死因子(TNFα),白細胞介素6(IL-6)的濃度.結果 側臥位後15 min(T0)、OLV後15 min(T1)、OLV後60 min(T2)和恢複雙肺通氣後15 minVCV組和PCV-VG組心率、MAP、TV、PETCO2、pH值和PaCO2組間差異均無統計學意義(均P＞0.05),側臥位後15 min(T0)和恢複雙肺通氣後15 min VCV組和PCV-VG組的Ppeak分彆為(16±3)、(16±3)cmH2O和(14 ±2)、(14 ±2)cmH2O,Cdyn分彆為(43.5±5.9)、(43.8±6.7)ml/cmH2O和(49.7±7.1)、(53.3±9.6)ml/cmH2O組間差異均有統計學意義(均P＜0.05),在OLV後15 min、OLV後60 minPCV-VG組的Ppeak分彆為(17±2)、(18±3)cmH2O顯著低于VCV組(22±4)、(23±3)cmH2O,PCV-VG組的Cdyn分彆為(38.6±6.3)、(37.3±6.0) ml/cmH2O顯著高于于VCV組(29.6±3.2)、(30.3±3.8) ml/cmH2O組間差異均有統計學意義(均P＜0.01),OLV後1h和手術後1 h PCV-VG組的IL-6分彆為(52.32±3.59)、(63.57±4.98) pg/ml顯著低于VCV組的(62.65±4.17)、(82.38±4.10) pg/ml,PCV-VG組的TNFα分彆為(3.23±0.27)、(4.01±0.28) pg/ml顯著低于VCV組的(4.19±0.38)、(5.49 ±0.31) pg/ml組間差異均有統計學意義(均P＜0.01).結論 在胸腔鏡下肺葉切除手術單肺通氣中,PCV-VG模式較VCV模式在肺功能和肺保護方麵具有更高的優勢.
목적 재단폐통기기간비교용량공제통기모식(VCV)화압력공제용량보증통기모식(PCV-VG)대순배、폐공능화폐손상적영향.방법 2012년2월지2013년3월재저파시제이의원심흉외과택기행흉강경하폐협절제30례환자,년령52 ～ 76세,미국마취의사협회(ASA)Ⅱ～Ⅲ급,수궤분성VCV조화PCV-VG조(매조15례),마취유도기관삽관후삽입지기관봉도도관,행건측단폐통기,분별우측와위후15 min(T0)、OLV후15 min(T1)、OLV후60 min(T2)화회복쌍폐통기후15 min(T3)기록심솔(HR)、평균동맥압(MAP)、실측조기량(TV)、기도봉압(Ppeak)、기도조력(Raw)、흉폐순응성(Cdyn)화호말이양화탄분압(PETCO2),동시추취동맥혈행혈기분석,검측pH치、혈양분압(PaO2)화혈이양화탄분압(PaCO2)등지표;재마취전(T0)、OLV후1 h(T1)화수술결속후1 h(T2),용매련면역흡부법(ELISA)측정종류배사인자(TNFα),백세포개소6(IL-6)적농도.결과 측와위후15 min(T0)、OLV후15 min(T1)、OLV후60 min(T2)화회복쌍폐통기후15 minVCV조화PCV-VG조심솔、MAP、TV、PETCO2、pH치화PaCO2조간차이균무통계학의의(균P＞0.05),측와위후15 min(T0)화회복쌍폐통기후15 min VCV조화PCV-VG조적Ppeak분별위(16±3)、(16±3)cmH2O화(14 ±2)、(14 ±2)cmH2O,Cdyn분별위(43.5±5.9)、(43.8±6.7)ml/cmH2O화(49.7±7.1)、(53.3±9.6)ml/cmH2O조간차이균유통계학의의(균P＜0.05),재OLV후15 min、OLV후60 minPCV-VG조적Ppeak분별위(17±2)、(18±3)cmH2O현저저우VCV조(22±4)、(23±3)cmH2O,PCV-VG조적Cdyn분별위(38.6±6.3)、(37.3±6.0) ml/cmH2O현저고우우VCV조(29.6±3.2)、(30.3±3.8) ml/cmH2O조간차이균유통계학의의(균P＜0.01),OLV후1h화수술후1 h PCV-VG조적IL-6분별위(52.32±3.59)、(63.57±4.98) pg/ml현저저우VCV조적(62.65±4.17)、(82.38±4.10) pg/ml,PCV-VG조적TNFα분별위(3.23±0.27)、(4.01±0.28) pg/ml현저저우VCV조적(4.19±0.38)、(5.49 ±0.31) pg/ml조간차이균유통계학의의(균P＜0.01).결론 재흉강경하폐협절제수술단폐통기중,PCV-VG모식교VCV모식재폐공능화폐보호방면구유경고적우세.
Objective To compare the effects of volume-controlled ventilation VCV) and pressure-controlled volume-guaranteed (PCV-VG) mode during one-lung ventilation (OLV) on circulation,pulmonary function and lung injury.Methods 2012 February to 2013 March in Ningbo No2.Hospital cardiothoracic surgery,30 patients aged 52 to 76 years (ASA grade Ⅱ-Ⅲ) undergoing elective thoracoscopic lobectomy were randomly divided into VCV group and PCV-VG group,with 15 cases in each group.After anesthesia induction and endotracheal intubation,endobronchial blocker was inserted to start OLV.Heart rate (HR),mean arterial pressure (MAP),measured tidal volume (TV),peak airway pressure (Ppeak),airway resistance (Raw),chest compliance (Cdyn) and the end-tidal carbon dioxide pressure (PetCO2) were recorded at the time point of 15 minutes after turning to the lateral position,15 minutes and 60 minutes after OLV,and 15 minutes after the resumption of two lung ventilation.In the meanwhile,arterial blood gas analysis was conducted to measure indicators of pH,oxygen tension (PaO2) and carbon dioxide partial pressure (PaCO2).Blood was drawn before induction,1 hour after OLV and 1 hour after the end of surgery,and the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA).Results HR,MAP,TV,PetCO2,pH and PaCO2 in two groups at the time point of 15 minutes after turning to the lateral position,15 minutes and 60 minutes after OLV,and 15 minutes after the resumption of two lung ventilation showed no significant difference (P ＞ 0.05).At the point of 15 minutes after turning to the lateral position and 15 minutes after two lung ventilation,Ppeak and Cdyn of two groups were significantly different (P ＜ 0.05) (Ppeak:16 ± 3 cmH2O,16 ± 3 cmH2O for VCV group and 14 ± 2 cmH2O,14 ± 2 cmH2O for PCV-VG group; Cdyn:43.5 ±5.9 ml/cmH2O,43.8 ±6.7 ml/cmH2O for VCV group and 49.7 ±7.1 ml/cmH2O,53.3 ± 9.6 ml/cmH2 O for PCV-VG group).Compared with VCV group,PCV-VG group showed a lower Ppeak 15 minutes and 60 minutes after OLV [(17 ± 2 cmH2 O) vs (22 ± 4 cmH2 O) and (18 ± 4 cmH2 O) vs (23 ±3 cmH2O) with a higher Cdyn at the same point (38.6 ±6.3 ml/cmH2O) vs (29.6 ±3.2 ml/cmH2 O) and 37.3 ± 6.0 ml/cmH2 O) vs (30.3 ± 3.8 ml/cmH2 O)] (P ＜ 0.01).Compared with VCVgroup,IL-6 and TNF-α of PCV-VG group 1 hour after OLV and 1 hour after the end of surgery were significantly lower (P ＜0.01) (IL-6:52.32 ±3.59 vs 62.65 ±4.17 pg/ml and 63.57 ±4.98 vs 82.38 ± 4.10 pg/ml; TNF-α:3.23 ±0.27 vs 4.19 ±0.38 pg/ml and 4.01 ±0.28 vs.5.49 ±0.31 pg/ml).Conclusion During one-lung ventilation in thoracoscopic lobectomy,PCV-VG mode has a competitive advantage over VCV mode in terms of pulmonary function and lung protection.
