肺保护性通气策略与常规容量控制通气对颅脑损伤患者血肿清除术中血气分析指标的影响对比

Comparison of influence of lung protective ventilation strategy and conventional volume controlled ventilation on blood gas analysis indicators during hematoma removal in patients with craniocerebral injury

目的探讨肺保护性通气策略(LPVS)与常规容量控制通气(VCV)对颅脑损伤患者血肿清除术中血气分析指标的影响效果差异。方法纳入2021年6月~2023年12月期间于某院行血肿清除术治疗的60例颅脑损伤患者,按照通气方式不同将其分为VCV组与LPVS组,每组30例。比较两组患者不同时间点[麻醉诱导前(T_(0))、机械通气开始(T_(1))、术毕关颅(T_(2))、术后24 h(T_(3))]血气分析指标[动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、血氧饱和度(SpO_(2))、氧合指数(PaO_(2)/FiO_(2))],对比两组不同时间点血流动力学[心率(HR)、平均动脉压(MAP)]、治疗结局(机械通气时间、ICU住院时间、6个月生存率)以及并发症发生情况。结果①血气分析指标:两组PaCO_(2)、PaO_(2)、SpO_(2)、PaO_(2)/FiO_(2)符合球形分布(P>0.05);与T_(0)时刻比较,两组PaCO_(2)在T_(1)~T_(3)时呈现先降低后升高趋势(P<0.05),且LPVS组在T_(1)~T_(2)时PaCO_(2)明显低于VCV组(P<0.05);与T_(0)时刻比较,两组在T_(1)~T_(3)时PaO_(2)、SpO_(2)均升高(P<0.05),两组PaO_(2)/FiO_(2)在T_(1)~T_(3)时呈现先升高后降低趋势(P<0.05),且LPVS组T_(1)~T_(2)时的PaO_(2)、PaO_(2)/FiO_(2)以及T_(2)时的SpO_(2)均高于VCV组(P<0.05)。②血流动力学:两组HR、MAP符合球形分布(P>0.05);与T_(0)时刻比较,两组HR在T_(1)~T_(3)时呈现先降低后升高趋势(P<0.05),且LPVS组T_(2)~T_(3)时的HR明显高于VCV组(P<0.05);与T_(0)时刻比较,两组MAP在T_(1)~T_(3)时均降低(P<0.05),且LPVS组在T_(1)~T_(2)时的MAP明显高于VCV组(P<0.05)。③治疗结局和并发症发生情况:LPVS组机械通气时间短于VCV组(P<0.05);两组ICU住院时间、6个月生存率比较,差异无统计学意义(P>0.05);LPVS组总并发症发生率低于VCV组(P<0.05)。结论LPVS较VCV可显著改善颅脑损伤患者血肿清除围术期的血气状态,调节血流动力学,缩短机械通气时长,降低术后肺部并发症风险。

Objective To investigate the influence of lung protective ventilation strategy(LPVS)and conventional volume controlled ventilation(VCV)on blood gas analysis indicators during hematoma removal in patients with craniocerebral injury.Methods Sixty patients with craniocerebral injury who received hematoma removal in the hospital were enrolled from June 2021 to December 2023.According to different ventilation methods,they were divided into VCV group and LPVS group,with 30 cases in each group.The blood gas analysis indicators[arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2)),blood oxygen saturation(SpO_(2)),oxygenation index(PaO_(2)/FiO_(2))]were compared between groups at different time points[before anesthesia induction(T_(0)),at the beginning of mechanical ventilation(T_(1)),closing skull after the end of surgery(T_(2)),at 24 h after surgery(T_(3))].The hemodynamics[heart rate(HR),mean arterial pressure(MAP)]at different time points,treatment outcomes(mechanical ventilation time,ICU stay time,6-month survival rate)and occurrence of complications were compared between the two groups.Results①Blood gas analysis indicators:In both groups,the PaCO_(2),PaO_(2),SpO_(2)and PaO_(2)/FiO_(2)conformed to spherical distribution(P>0.05).Compared with T_(0),PaCO_(2)in the two groups showed a trend of decreasing first and then increasing at T_(1)-T_(3)(P<0.05),and at T_(1)-T_(2),the PaCO_(2)in LPVS group was significantly lower than that in VCV group(P<0.05).Compared with T_(0),PaO_(2),SpO_(2)at T_(1)-T_(3)showed a continuous upward trend(P<0.05),and PaO_(2)/FiO_(2)in the two groups increased first and then decreased at T_(1)-T_(3)(P<0.05),and SpO_(2)at T_(2)and PaO_(2),PaO_(2)/FiO_(2)at T_(1)-T_(2)in LPVS group were significantly higher than those in VCV group(P<0.05).②Hemodynamics:In both groups,the HR,MAP conformed to spherical distribution(P>0.05).Compared with T_(0),the HR in the two groups showed a trend of decreasing first and then increasing at T_(1)-T_(3)(P<0.05),and HR at T_(2)-T_(3)in LPVS group were significantly higher than those in VCV group(P<0.05).Compared with T_(0),the MAP at T_(1)-T_(3)in the two groups showed a decreasing trend(P<0.05),and the MAP at T_(1)-T_(2)in LPVS group were significantly higher than those in VCV group(P<0.05).③Treatment outcomes and complications:The mechanical ventilation time in LPVS group was shorter than that in VCV group(P<0.05),but there were no significant difference in ICU stay time and 6-month survival rate between groups(P>0.05).The total incidence rate of complications in LPVS group was lower than that in VCV group(P<0.05).Conclusion Compared with VCV,LPVS can significantly improve the perioperative blood gas status,regulate the hemodynamics,shorten the mechanical ventilation time,and reduce the risk of postoperative lung complications in patients with craniocerebral injury.