压力控制容量保证通气模式改善创伤性脑损伤患者早期预后

Pressure-controlled ventilation-volumeguaranteed improved early prognosis of patients undergoing traumatic brain injury

目的分析不同通气模式下创伤性脑损伤(TBI)患者的呼吸指标、脑组织炎症指标、肺部感染评分,评价压力控制容量保证通气(PCV-VG)模式对创伤性脑损伤患者早期预后的作用。方法选择2017年4月至2020年4月急诊行仰卧位脑血肿清除术的TBI患者100例,男55例,女45例,年龄40~65岁,BMI 18~28 kg/m^(2),ASAⅢ或Ⅳ级,术前格拉斯哥昏迷评分(GCS)5~12分。采用随机数字表法将患者分为两组:压力控制容量保证通气组(P组)和容量控制通气组(V组),每组50例。P组采用PCV-VG模式,V组采用VCV模式。于机械通气即刻(T 1)、机械通气后60 min(T 2)、手术结束即刻(T 3)采集桡动脉血进行血气分析,记录T 1—T 3时HR、MAP、PaO 2、PaCO 2、肺部动态顺应性(Cdyn)、气道峰压(Ppeak)及气道平台压(Pplat)。于T 1—T 3时采集颈内静脉血样,采用ELISA法测定血清纤维胶质酸性蛋白(GFAP)、TNF-α、泛素羧基化水解酶1(UCH-L1)浓度;记录术后3 d和7 d的临床肺部感染评分(CPIS)评估肺部感染情况。结果与T 1时比较,T 2时V组PaO 2、Cdyn明显下降(P<0.05),Ppeak、Pplat明显升高(P<0.05);T 3时两组PaO 2、Cdyn明显下降(P<0.05),Ppeak、Pplat明显升高(P<0.05);T 2、T 3时两组血清GFAP、TNF-α、UCH-L1浓度均明显升高(P<0.05)。与V组比较,T 2、T 3时P组PaO 2、Cdyn明显升高(P<0.05),Ppeak、Pplat明显降低(P<0.05),血清GFAP、TNF-α、UCH-L1浓度均明显降低(P<0.05);术后3 d和7 d P组CPIS明显降低(P<0.05)。结论PCV-VG模式可以改善TBI患者呼吸指标,减轻脑组织炎症反应及肺部感染,从而改善患者早期预后。

Objective To analyse respiratory index、inflammation of brain tissue and pulmonary infection of patients undergoing traumatic brain injury(TBI)in different ventilation modes.To evaluate the effects of pressure-controlled ventilation-volumeguaranteed(PCV-VG)on early prognosis of patients undergoing traumatic brain injury.Methods One hundred TBI patients underwent emergency cerebral hematoma removal,55 males and 45 famales,aged 40-65 years,BMI 18-28 kg/m^(2),ASA physical statusⅢorⅣand glasgow coma scale(GCS)5-12 points,were randomly divided into pressure-controlled ventilation-volumeguaranteed group(group P)and volume-controlled ventilation group(group V),50 patients in each group.Group P adopts pressure controlled volume guaranteed ventilation mode and group V adopts volume controlled ventilation mode.At the moment of mechanical ventilation(T 1),mechanical ventilation for 60 minutes(T 2),at the end of surgery(T 3),HR,MAP,PaO 2,PaCO 2,pulmonary dynamic compliance(Cdyn),airway peak pressure(Ppeak)and airway plateau pressure(Pplat)were measured to evaluate hemodynamics and respiratory function.Blood samples from the patient’s internal jugular vein were taken at the above time points to determine serum glial fibrillary acidic protein(GFAP),tumor necrosis factor-α(TNF-α)and ubiquitin c-terminal hydrolase-L1(UCH-L1)and evaluate inflammation of brain tissue.Clinical pulmonary infection score(CPIS)3 and 7 days after surgery was used to evaluate the pulmonary infection.Results Compared with T 1,PaO 2 and Cdyn were decreased(P<0.05),Ppeak and Pplat were increased(P<0.05)in group V at T 2,PaO 2 and Cdyn were decreased(P<0.05),Ppeak and Pplat were increased(P<0.05)in two groups at T 3,concentrations of serum GFAP,TNF-αand UCH-L1 in two groups at T 2 and T 3 were increased significantly(P<0.05).Compared with group V,PaO 2 and Cdyn were significantly increased(P<0.05),Ppeak and Pplat were decreased(P<0.05),concentrations of serum GFAP,TNF-αand UCH-L1 were decreased(P<0.05)in group P at T 2 and T 3,CPIS scores was decreased significantly in group P 3 days and 7 days after surgery(P<0.05).Conclusion The application of PCV-VG ventilation mode can improve respiratory index,reduce inflammation of brain tissue and pulmonary infection in patients with TBI,and can improve early prognosis of patients.