压力控制容量保证通气模式对胸腔镜下行肺叶切除术老年患者术中通气效果及术后肺部并发症的影响

Effects of pressure controlled ventilation-volume guaranteed mode on intraoperative pulmonary ventilation and postoperative pulmonary complications in elderly patients undergoing thoracoscopic lobectomy

目的探讨压力控制容量保证通气(PCV-VG)模式对胸腔镜下肺叶切除术老年患者术中通气效果及术后肺部并发症(PPC)的影响。方法选择山西医科大学第二医院2021年11月至2022年6月全身麻醉下行胸腔镜下肺叶切除术患者60例,美国麻醉医师协会(ASA)分级Ⅱ级或Ⅲ级,年龄65~80岁,体质量指数(BMI)18~30 kg/m^(2)。采用随机数字表法将患者分为PCV-VG组和容量控制通气(VCV)组,每组30例。双肺通气期间呼吸参数设置为呼吸频率(RR)10~12次/min,潮气量(VT)8 ml/kg(理想体质量)。单肺通气(OLV)期间呼吸参数设置为RR 12~16次/min,VT 6 ml/kg(理想体质量)。记录OLV前1 min(T_(0))、OLV 30 min(T_(1))、OLV 60 min(T_(2))时的气道峰压(Ppeak)、气道平台压(Pplat)、驱动压(ΔP)、动态肺顺应性(Cdyn)及呼气末二氧化碳(ETCO_(2))、心率(HR)、平均动脉压(MAP)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))。记录术后住院期间PPC发生情况、严重程度、胸管留置时长及术后住院时长。结果与T_(0)时相比,T_(1)、T_(2)时两组Ppeak、Pplat、ΔP均升高,Cdyn均降低(均P<0.001)。与VCV组相比,各时间点PCV-VG组Ppeak、Pplat、ΔP均降低,Cdyn均升高(均P<0.05)。两组各时间点HR、MAP、ETCO_(2)、PaO_(2)、PaCO_(2)比较,差异均无统计学意义(均P>0.05)。VCV组与PCV-VG组间PPC发生率[43.3%(13/30)比30.0%(9/30)]及胸管留置时长[(4.4±0.9)d比(4.2±1.2)d]差异均无统计学意义(均P>0.05)。PCV-VG组PPC分级≥2级患者比例低于VCV组[10.0%(3/30)比36.7%(11/30),χ^(2)=5.96,P<0.05],术后住院时长短于VCV组[(6.4±1.3)d比(8.0±1.9)d,t=4.85,P<0.05]。结论PCV-VG模式可有效降低胸腔镜下肺叶切除术老年患者PPC严重程度,缩短术后住院时长,改善患者预后。

Objective To explore the effects of pressure controlled ventilation-volume guaranteed(PCV-VG)mode on intraoperative pulmonary ventilation and postoperative pulmonary complications(PPC)in elderly patients undergoing thoracoscopic lobectomy.Methods Sixty patients of American Society of Anesthesiologists(ASA)classificationⅡorⅢ,aged 65-80 years old,with body mass index(BMI)18-30 kg/m^(2),received thoracoscopic lobectomy under general anesthesia from November 2021 to June 2022 in the Second Hospital of Shanxi Medical University were recruited.The patients were divided into PCV-VG and volume-controlled ventilation(VCV)groups using the randomized number table method,with 30 patients in each group.The ventilatory parameters of two-lung ventilation were set to respiratory rate(RR)at 10-12 breaths/min,with a tidal volume(VT)of 8 ml/kg(ideal body weight).The ventilatory parameters of one-lung ventilation(OLV)were set at 12-16 breaths/min,with a VT of 6 ml/kg(IBW).The peak airway pressure(Ppeak),plateau airway pressure(Pplat),driving pressure(ΔP),dynamic lung compliance(Cdyn),end-tidal carbon dioxide(ETCO_(2)),heart rate(HR),mean arterial pressure(MAP),partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were obtained at 1 min before OLV(T_(0)),30 min after OLV(T_(1))and 60 min after OLV(T_(2)).The incidence and severity of PPC,chest tube duration time and postoperative hospital stay time were recorded.Results The Ppeak,Pplat andΔP were higher and Cdyn was lower in both groups at T_(1)-T_(2) than at T_(0)(all P<0.001).The Ppeak,Pplat andΔP were higher and Cdyn was lower in PCV-VG group than in VCV group(all P<0.05).There were no statistical differences in HR,MAP,ETCO_(2),PaO_(2) and PaCO_(2) between the two groups(all P>0.05).There were no statistical differences in the incidence of PPC[43.3%(13/30)vs.30.0%(9/30)]and chest tube duration time[(4.4±0.9)d vs.(4.2±1.2)d]between VCV group and PCV-VG group(all P>0.05).Compared with VCV group,the proportion of patients with≥grade 2 PPC was lower in PCV-VG group[10.0%(3/30)vs.36.7%(11/30),χ^(2)=5.96,P<0.05].The postoperative hospital stay time in PCV-VG group was shorter than that in VCV group[(6.4±1.3)d vs.(8.0±1.9)d,t=4.85,P<0.05].Conclusions PCV-VG mode can effectively reduce the severity of PPC,shorten the postoperative hospital stay time and improve the prognosis in elderly patients undergoing thoracoscopic lobectomy.