基于P-V曲线个体化LPVS联合PCV-VG模式用于肺癌根治术单肺通气老年患者的优化效果

Optimization efficacy of individualized LPVS based on P-V curve combined with PCV-VG mode for OLV in elderly patients undergoing radical resection of lung cancer

目的评价基于P-V曲线个体化肺保护性通气策略联合压力控制-容量保证通气(LPVS+PCV-VG)模式用于肺癌根治术单肺通气(OLV)老年患者的优化效果。方法择期胸腔镜肺癌根治术患者70例,年龄65~74岁,ASA分级Ⅱ或Ⅲ级,BMI 18~24 kg/m^(2),采用随机数字表法分为2组(n=35):PCV-VG组和LPVS+PCV-VG组。于全麻醉诱导前(T_(0))、气管插管术后双肺通气5 min(T_(1))、OLV 30 min(T_(2))、OLV结束时(T_(3))和平卧位双肺通气5 min(T_(4))时采集桡动脉血样行血气分析,测定Ppeak、平均气道压(Pmean)和肺动态顺应性(Cdyn)。记录术后7 d内抗生素使用、肺部相关并发症发生及康复情况。结果与PCV-VG组相比,LPVS+PCV-VG组T_(2)~4时PaO_(2)、PaCO_(2)和Cdyn升高,T_(2),3时Ppeak降低,T_(3)时Pmean升高,术后7 d内抗生素使用率降低,肺部相关并发症1级发生率降低,胸腔引流管留置时间和住院时间缩短(P<0.05)。结论基于P-V曲线个体化LPVS联合PCV-VG模式用于肺癌根治术OLV老年患者的效果更佳。

Objective To evaluate the optimization efficacy of pressure-volume(P-V)curve-based individualized lung-protective ventilation strategy combined with pressure-controlled ventilation-volume guaranteed(PCV-VG)mode(LPVS+PCV-VG)for one-lung ventilation(OLV)in elderly patients undergoing radical resection of lung cancer.Methods Seventy American Society of Anesthesiologists Physical Status classificationⅡ-Ⅲpatients,aged 65-74 yr,with body mass index of 18-24 kg/m^(2),undergoing elective thoracoscopic radical resection of lung cancer,were divided into 2 groups(n=35 each)using a random number table method:PCV-VG group and LPVS+PCV-VG group.Blood samples were collected from the radial artery for blood gas analysis before induction of general anesthesia(T_(0)),at 5 min of two lung ventilation after endotracheal intubation(T_(1)),at 30 min of OLV(T_(2)),at the end of OLV(T_(3)),and at 5 min of two lung ventilation in supine position(T_(4)).Ppeak,mean airway pressure(Pmean)and dynamic lung compliance(Cdyn)were recorded.The use of antibiotics,lung-related complications and rehabilitation were recorded within 7 days after operation.Results Compared with PCV-VG group,PaO_(2),PaCO_(2) and Cdyn were significantly increased at T_(2-4),Ppeak was decreased at T_(2,3),Pmean was increased at T_(3),the requirement for antibiotics within 7 days after operation was decreased,the incidence of 1 grade lung-related complications was decreased,and the thoracic drainage tube indwelling time and length of hospital stay were shortened in LPVS+PCV-VG group(P<0.05).Conclusions Individualized LPVS based on P-V curve combined with PCV-VG mode provides better efficacy for OLV in elderly patients undergoing radical resection of lung cancer.