探讨可优化性肺保护通气策略在中-重型创伤性颅脑损伤患者围术期中的作用

Exploration of the Role of Optimizable Lung-protective Ventilation Strategies in the Perioperative Period in Patients with Moderate-to-severe Traumatic Craniocerebral Injuries

目的:探讨可优化性肺保护通气策略(LPVS)在中-重型创伤性颅脑损伤(TBI)患者围术期肺部等转归中的作用。方法:选取2020年2月—2021年2月德阳市人民医院收治的52例创伤性中-重型颅脑损伤患者作为研究对象,实施围术期LPVS,所有患者均采取压力调节容量控制(PRVC)通气,PRVC参数设置:Vol 6~8 mL/kg,RR 10~15 bpm,Ti∶Te=1∶2,呼气未正压(PEEP) 5 cmH_(2)O,FiO_(2) 50%,氧流量1~2 L/min,每隔120 min采取压力控制法(PCV)肺复张。记录麻醉诱导前(T0)、PRVC开始(T1)、PRVC后首次监测ICP (T2)、PRVC+PCV后关颅(T3)以及术后12 h (T4)、24 h(T5)、48 h (T6)、72 h (T7)、5 d (T8)的平均动脉压(MAP)、SPO_(2)、PetCO_(2)、ICP,测算脑灌注压(CPP);于各观察时点记录PRVC+PCV前后PaO_(2)、PaCO_(2)、记录手术时长、失血量、PRVC时长。结果:接受LPVS的患者采取PRVC,给予PCV肺复张,PaO_(2)、SpO_(2)、OI明显升高,T7、T8值改善明显高于T0、T1、T2,肺氧合功能改善。结论:可优化性LPVS拥有较好地预防肺不张、肺损伤,优化肺氧合功能,改良肺部转归,是中-重型围术期肺部非生理条件下机械通气呼吸的较理想管理方法。

Objective:To investigate the role of optimizable lung-protective ventilation strategies in perioperative pulmonary isotope regression in patients with moderate-to-severe traumatic craniocerebral injury (TBI).Methods:52 patients with traumatic moderate-heavy craniocerebral injuries admitted to the hospital from February 2020 to February 2021 were selected as the study subjects to implement perioperative optimizable lung-protective ventilation strategy (LPVS),and all of them were ventilated with pressure-regulated volume control (PRVC).PRVC parameter was set:Vol 6~8 mL/kg,RR 10~15 bpm,Ti∶Te=1∶2,PEEP5 cmH_2O,FiO_(2 )50%,oxygen flow rate 1~2 L/min,and pressure-controlled method (PCV) of pulmonary reexpansion was taken every 120 min.Mean arterial pressure (MAP),SPO_(2),PetCO_(2),and ICP were recorded before induction of anesthesia (T0),at the beginning of PRVC (T1),at the first monitoring of ICP after PRVC (T2),at the cranial closure after PRVC+PCV (T3),as well as at12 h (T4),24 h (T5),48 h (T6),72 h (T7),and 5 d (T8) postoperatively,and the cerebral perfusion pressure (CPP) was measured PaO_(2) and PaCO_(2) were recorded before and after PRVC+PCV at each observation time point,and the length of surgery,blood loss and length of PRVC were recorded to document postoperative pulmonary regression and postoperative cerebral infarction.Results:Patients who received LPVS took PRVC and were given PCV for pulmonary reexpansion,with significantly higher PaO_(2),SpO_(2),and OI,significantly higher improvement in T7 and T8 values than T0,T1,and T2,and improvement in pulmonary oxygenation function.Conclusion:Optimizability LPVS possesses better prevention of pulmonary atelectasis,lung injury,optimization o pulmonary oxygenation function,and improved pulmonary regression,making it a more ideal management of mechanically ventilated respiration in non-physiological conditions of the lungs in the moderate-to-severe perioperative period.