不同单肺通气模式对胸腔镜肺癌根治术动脉氧合及手术预后的影响

Effects of Different One-lung Ventilation Modes on Arterial Oxygenation and Surgical Prognosis in Thoracoscopic Radical Resection of Lung Cancer

目的:探讨不同的单肺通气模式对胸腔镜肺癌根治术患者动脉氧合及手术预后的影响。方法:选取福建医科大学附属协和医院2014年10月-2015年2月收治的40例行胸腔镜肺癌根治术的患者作为研究对象,根据随机数字表法分为两组,A组[单肺通气时行容量控制(VCV)]和B组[单肺通气时行压力控制(PCV)],每组20例。统计分析两组双肺通气30 min(T_(1))、单肺通气30 min(T_(2))、单肺通气60 min(T_(3))、恢复双肺通气20 min(T_(4))时气道峰压(Ppeak)、气道平台压(Pplat)、肺顺应性、氧合指数、术后住院天数及术后并发症的发生率。结果:T_(2)、T_(3)时,两组氧合指数均较T_(1)时下降(P<0.05);T_(1)、T_(2)、T_(3)、T_(4)时,两组氧合指数比较差异无统计学意义(P>0.05)。T_(2)、T_(3)时,两组Ppeak、Pplat均较T_(1)时升高(P<0.05),且与A组相比,B组Ppeak较低(P<0.05),两组各时刻Pplat比较差异无统计学意义(P>0.05)。T_(2)、T_(3)时,两组肺顺应性较T_(1)时下降,两组各时刻肺顺应性比较差异无统计学意义(P>0.05)。两组术后住院天数、术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:胸腔镜肺癌根治术患者在低潮气量联合呼气末正压通气的单肺通气期间,与VCV模式相比,PCV模式并不能明显改善肺顺应性、氧合功能及手术预后,但PCV模式可起到限制气道压的作用。

Objective:To investigate the effect of different one-lung ventilation modes on arterial oxygenation and prognosis of operation undergoing thoracoscopic radical resection of lung cancer.Method:From October 2014 to February 2015,40 cases of lung cancer patients undergoing thoracoscopic radical pulmonary resection in Fujian Medical University Union Hospital were selected as the study objects.According to random number table method,they were divided into group A[volume control ventilation(VCV)during onelung ventilation]and group B[pressure control ventilation(PCV)during one-lung ventilation],with 20 cases in each group.The peak airway pressure(Ppeak),plat airway pressure(Pplat),lung compliance,oxygenation index at two-lung ventilation for 30 min(T_(1)),onelung ventilation for 30 min(T_(2)),one-lung ventilation for 60 min(T_(3)),two-lung ventilation for 20 min(T_(4)),in-hospital length of stay and the incidence of postoperative complications were statistical analyzed in both groups.Result:At T_(2),T_(3),oxygenation index of both groups decreased compared with that at T_(1)(P<0.05);there were no significant difference in oxygenation index between the two groups at T_(1),T_(2),T_(3) and T_(4)(P>0.05);at T_(2),T_(3),Ppeak,Pplat in both groups increased compared with that at T_(1)(P<0.05),and Ppeak in group B was lower than that in group A(P<0.05).There were no significant differences in Pplat between the two groups at each time(P>0.05).At T_(2),T_(3),the lung compliance of the two groups decreased compared with that at T_(1),and there were no statistical significances in the comparison of lung compliance between the two groups at each time(P>0.05).There were no significant differences in the in-hospital length of stay and the incidence of postoperative complications between the two groups(P>0.05).Conclusion:Compared with VCV mode,PCV mode does not significantly improve lung compliance,oxygenation function and surgical prognosis in patients undergoing thoracoscopic radical lung cancer surgery during one-lung ventilation with low tidal volume combined with positive end-expiratory pressure ventilation,but PCV mode can play a role in limiting airway pressure.