保护性肺通气策略对口腔癌患者术后氧合功能的影响

Effect of protective lung ventilation strategy on postoperative oxygenation in patients with oral cancer

目的:探讨保护性肺通气策略(LPVS)对口腔癌患者术后氧合功能的影响。方法:选择全麻下行口腔癌手术患者90例,随机分为3组:常规潮气量组(A组)、小潮气量+低呼气末正压通气(PEEP)组(B组)、小潮气量+低PEEP+肺复张组(C组),每组30例。记录每组患者术前(T1)、机械通气2 h(T3)、手术结束时(T4)、术后24 h(T5)和72 h(T6)的动脉氧分压(PaO2)、肺泡动脉血氧分压差[P(A-a)DO2]和氧合指数(OI);记录患者机械通气后30 min(T2)、T3和T4的气道压峰值(PAP)以及计算动态肺顺应性(CL);记录患者T1、T5和T6的白细胞(WBC)、C反应蛋白(CRP)、临床改良肺部感染评分(mCPIS)。结果:3组患者各时点P(A-a)DO2、PaO2均较术前升高,术中PAP值呈上升趋势,T5、T6时点WBC、CRP和mCPIS评分也均较T1时点升高,其中B组、C组PAP、P(A-a)DO2、CRP和mCPIS评分升高幅度明显低于A组(P<0.05);3组患者各时点OI较术前下降,且术中CL呈下降趋势,其中B组、C组OI、CL下降幅度低于A组(P<0.05)。3组术中均无严重不良事件发生。结论:口腔癌手术患者术中应用LPVS有利于促进术后早期肺氧合功能的恢复。

Objective:To investigate the influence of lung protective ventilation strategy(LPVS)on postoperative oxygenation in oral cancer patients.Methods:Ninety patients with oral cancer who received surgery under general anesthesia were randomly divided into three groups(n=30 per group):conventional ventilation group(group A),low tidal volume+low positive end-expiratory pressure ventilation(PEEP)(group B)and low tidal volume+low PEEP+lung recruitment maneuver group(group C).At preoperation(T1),2 h mechanical ventilation(T3),the end of surgery(T4),24 h postoperation(T5)and 72 h postoperation(T6),the partial pressure of oxygen(PaO2),alveolar-arterial oxygen pressure difference[P(A-a)DO2]and oxygenation index(OI)were recorded.The peak airway pressure(PAP)and dynamic lung compliance(CL)after 30 min of mechanical ventilation(T2),T3,and T4 were recorded.The white blood cell(WBC),C-reactive protein(CRP)and modified clinical pulmonary infection score(mCPIS)at T1,T5 and T6 were evaluated.Results:P(A-a)DO2 and PaO2 at each time point after surgery were increased while the OI was decreased in all groups,and the PAP during surgery was increased whereas CL was decreased(P<0.05).The WBC,CRP and mCPIS at T5 and T6 were significantly elevated compared with T1(P<0.05).These changes were more marked in group A(P<0.05).There was no severe adverse event in each group during surgery.Conclusion:The application of LPVS during surgery in patients with oral cancer is beneficial to the recovery of early postoperative pulmonary oxygenation.