不同单肺通气模式对胸腔镜下肺癌根治术呼吸力学及氧化应激的影响

Effects of different modes of one-lung ventilation on respiratory physiology and oxidative stress in thoracoscopic radical resection of lung cancer

目的比较2种单肺通气模式对胸腔镜下右肺癌根治术患者气道压力及氧化应激因子水平的影响。方法选择拟行胸腔镜下右肺癌根治术需单肺通气的患者62例,采用随机数字表法分组,分为容量控制通气(VCV)组和压力控制通气(PCV)组,每组31例。2组在双肺通气期间均采用VCV通气。单肺通气开始后,VCV组潮气量为6ml/kg,呼气末正压为0cmH2O(1cmH2O=0.098kPa);PCV组:先用VCV模式,调节气道压力至潮气量达到6ml/kg,改为PCV模式,呼气末正压为0cmH2O,调节通气频率,使呼气末二氧化碳分压的值维持在30~45mmHg(1mmHg=0.133kPa)。2组在进胸前双肺通气开始后10min(T1)及单肺通气开始后30min(T2)、60min(T3)、120min(T4)4个时间点采集桡动脉血2ml行血气分析。2组患者分别在T1、T3、T4时间点采取桡动脉血血清检测丙二醛(MDA)和超氧化物歧化酶(SOD)。结果2组在各时间点的血流动力学参数差异无统计学意义。在T3、T4时PCV组的气道峰压分别为(22.00±4.44)、(21.68±4.55)cmH2O,显著低于VCV组[(25.00±4.14)、(25.00±4.03)cmH2O]。在T3、T4时PCV组的MDA分别为(6.64±2.15)、(7.11±1.50)μmol/L,显著低于VCV组[(7.31±2.09)、(8.00±1.83)μmol/L];PCV组的SOD分别为(39.42±15.36)、(37.49±13.02)U/ml,显著高于VCV组[(35.94±8.47)、(31.72±7.83)U/ml]。2组的动脉血氧分压、动脉血二氧化碳分压在单肺通气期间差异无统计学意义。结论肺癌患者胸腔镜下肺癌根治术采用PCV通气模式有利于降低气道峰压,同时降低氧化应激因子水平,从而可能有利于减少气道损伤。

Objective To explore the effects of two different modes for one-lung ventilation on airway pressure and oxidative stress factors during thoracoscopic radical resection of right lung cancer. Methods Sixty-two patients who needed one-lung ventilation after thoracoscopic radical resection of right lung cancer were divided into volume-controlled ventilation (VCV) group and pressure-controlled ventilation (PCV) group by random number table.VCV was used in both groups during dual lung ventilation.In VCV group, tidal volume was 6 ml/kg, positive end-expiratory pressure was 0 cmH2O (1 cmH2O=0.098 kPa). In PCV group, VCV mode was firstly used to regulate airway pressure to tidal volume at 6 ml/kg, then PCV mode was used, positive end-expiratory pressure was 0 cmH2O, and ventilation frequency was adjusted to maintain the value of end-tidal carbon dioxide partial pressure at 30-45 mmHg (1 mmHg=0.133 kPa). Radial artery blood was collected for blood gas analysis at 10 minutes (T1) before dual lung ventilation and 30 minutes (T2), 60 minutes (T3) and 120 minutes (T4) after one-lung ventilation.Malondialdehyde (MDA) and superoxide dismutase (SOD) in radial artery blood serum were measured at T1, T3 and T4 time points in the two groups. Results There was no significant difference in hemodynamic parameters between the two groups at different time points.At T3 and T4, the peak airway pressures of PCV group were (22.00±4.44) and (21.68±4.55) cmH2O, which were significantly lower than those of VCV group [(25.00±4.14), (25.00±4.03) cmH2O]. At T3 and T4, MDA of PCV group was (6.64±2.15), (7.11±1.50) μmol/L, which was significantly lower than that of VCV group [(7.31±2.09), (8.00±1.83) μmol/L], and SOD of PCV group was (39.42±15.36), (37.49±13.02) U/ml, which was significantly higher than that of VCV group [(35.94±8.47), (31.72±7.83) U/ml]. There was no significant difference in arterial partial pressure of oxygen and carbon dioxide between the two groups during one-lung ventilation. Conclusions PCV in thoracoscopic radical resection of lung cancer is helpful to reduce peak airway pressure and levels of oxidative stress factors, which may be helpful to reduce airway injury.