不同通气模式对后腹腔镜手术患者肺损伤的影响

Effect of different ventilation modes on lung injury in patients performed with retroperitoneal laparoscopic surgeries

目的探讨行后腹腔镜手术的患者在压力控制-容量保证(PCV-VG)通气模式与传统容量控制(VCV)通气模式下对肺损伤的影响。方法选取2017年8~12月我院行后腹腔镜手术的患者60例,按随机数字双盲法分为PCV-VG组(P组)和VCV组(V组),每组30例。按预设通气参数通气,分别在T1~T4(气管插管后5 min、气腹后30 min、气腹后90 min、气腹结束后30 min)记录气道峰压(Ppeak)、平均气道压(Pmean)、呼气末二氧化碳(PetCO2)、计算不同时刻的肺顺应性(Cd),抽动脉血监测各个时刻血浆白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(s ICAM-1)的浓度。比较两组呼吸力学参数的变化及IL-6、TNF-α、s ICAM-1的浓度。结果 P组在T1~T4时刻的平均气道压、气道峰压及血浆IL-6、TNF-α、s ICAM-1浓度明显低于V组(P<0.05);P组在T2、T3、T4时刻的Cd高于V组(P<0.05)。结论 PCV-VG模式可降低后腹腔镜手术患者的Ppeak、气道平均压,增加肺的顺动态应性,可降低IL-6、TNF-α、s ICAM-1的血浆浓度,在一定程度上减少肺损伤的发生。

Objective To compare the influence of pressure control ventilation – volume guaranteed（PCV-VG） and volume controlled ventilation（VCV） on lung injury in patients performed with retroperitoneal laparoscopic surgeries.Methods From August to December 2017, 60 patients performed with retroperitoneal laparoscopic surgeries in our hospital were selected. They were divided into two groups by a random double-blinding： PCV-VG group（Pgroup） and VCV group（Vgroup） with 30 cases in each group. Ventilation was carried out based on the preset ventilation parameters. At T1-T4（5 min after tracheal intubation, 30 min after pneumoperitoneum, 90 min after pneumoperitoneum, and30 min after pneumoperitoneum ending）, the Ppeak, Pmean, and end-tidal carbon dioxide（Pet CO2） were recorded, lung compliance at various times（Cd） was calculated, and the concentrations of plasma interleukin-6（IL-6）, tumor necrosis factor-α（TNF-α）, and soluble intercellular cell adhesion molecule-1（s ICAM-1） were monitored at each time by drawing arterial blood.The changes of respiratory mechanics parameters and the concentrations of IL-6, TNF-α and s ICAM-1 were compared between the two groups. Results In group P, Pmean, Ppeak, plasma IL-6, TNF-α and s ICAM-1 concentrations at T1-T4 were significantly lower than those in group V（P〈0.05）. In group P, the Cd values at T2, T3, T4 were higher than those in group V（P〈0.05）. Conclusion The PCV-VG mode can decrease the Ppeak and Pmean in patients undergoing retroperitoneal laparoscopic surgery, increase Cd values, and reduce plasma concentrations of IL-6, TNF-α and s ICAM-1, and control the occurrence of lung injury to some extent.