PCV-VG模式对单肺通气患者术中PaCO_2与PetCO_2相关性影响的研究
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摘要
目的:探讨PCV-VG通气模式对单肺通气期间PaCO_2与PetCO_2相关性的影响。方法:选择择期行食管癌根治术的患者60例,年龄35~65岁,ASA分级Ⅰ~Ⅱ级,随机分为容量控制通气(VCV)组(V组)与压力控制容量保证通气(PCV-VG)组(P组),每组30例。两组均于双肺通气15min(T0),单肺通气15min(T1)、30min(T2)、60min(T3)、90min(T4)记录呼气末二氧化碳分压(PetO_2),气道峰压(Ppeak),气道平台压(Pplat),同时采集动脉血行血气分析记录动脉血氧分压(PaO_2),动脉血二氧化碳分压(PaCO_2)。结果:V组在各时间点的Ppeak和Pplat均高于P组;两组的PaO_2在各时间点无统计学差异(P=0.612),在T1~T4时间点两组PaO_2均低于同组T0(P <0.001)。各时间点P组的PaCO_2与PetCO_2的相关系数均高于V组,但相较于T0,其余各时间点两组中PaCO_2与PetCO_2的相关性均降低。结论:相较于VCV通气,采用PCV-VG模式实施单肺通气可以更好地保持PaCO_2与PetCO_2的相关性。相较于双肺通气,两种通气模式术中PaCO_2与PetCO_2的相关性均降低。PCV-VG模式在保证氧供的同时,可以有效降低气道峰压与气道平台压,减小肺气压伤风险,可安全应用在食管癌根治术的单肺通气中。
Objective: To analyze the effect of the pressure-controlled volume-guaranteed(PCV-VG) mode on the correlation between PaCO_2 and PetCO_2 during one lung ventilation. Methods A total of 60 patients with radical resection of esophageal carcinoma were selected,aged 35-65 yr,were divided into 2 groups(n = 30 each) using a random number table:volume-controlled ventilation group(group V) and PCV-VG group(group P). The ventilator settings were adjusted,with a tidal volume 8 m L/kg and respiratory rate 12 breaths/min during two-lung ventilation(TLV),and with a tidal volume 6 m L/kg and respiratory rate 15 breaths/min during OLV. The inspiratory/expiratory ratio was 1: 2 and 75% fraction of inspired oxygen(FiO_2) at 1.5 L/min. Arterial blood gas analysis and respiration parameter were determined 15 minutes after TLV(T0),15 min(T1),30 min(T2),60 min(T3),90 min(T4) after OLV. Results Ppeak and Pplat in group V were higher than that in group P at all time points.There was no statistical difference in PaO_2 between the two groups at each time point(P = 0.612),and PaO_2 at t1-t4 was lower than that of the same group(P <0.001).The correlation coefficient between PaCO_2 and PetCO_2 in P group was higher than that in V group at each time point,but the correlation between PaCO_2 and PetCO_2 in the other two groups was lower than that in T0 group. Conclusion: Compared with VCV ventilation,single lung ventilation with PCVVG model can better maintain the correlation between PaCO_2 and PetCO_2. Compared with double lung ventilation,the correlation between PaCO_2 and PetCO_2 in the two ventilation modes are both decreased. In addition,the PCV-VG model can effectively reduce the peak airway pressure and airway plateau pressure and reduce the risk of lung pressure injury while ensuring oxygen supply. It can be safely used in one-lung ventilation after radical resection of esophageal cancer.
Objective: To analyze the effect of the pressure-controlled volume-guaranteed(PCV-VG) mode on the correlation between PaCO_2 and PetCO_2 during one lung ventilation. Methods A total of 60 patients with radical resection of esophageal carcinoma were selected,aged 35-65 yr,were divided into 2 groups(n = 30 each) using a random number table:volume-controlled ventilation group(group V) and PCV-VG group(group P). The ventilator settings were adjusted,with a tidal volume 8 m L/kg and respiratory rate 12 breaths/min during two-lung ventilation(TLV),and with a tidal volume 6 m L/kg and respiratory rate 15 breaths/min during OLV. The inspiratory/expiratory ratio was 1: 2 and 75% fraction of inspired oxygen(FiO_2) at 1.5 L/min. Arterial blood gas analysis and respiration parameter were determined 15 minutes after TLV(T0),15 min(T1),30 min(T2),60 min(T3),90 min(T4) after OLV. Results Ppeak and Pplat in group V were higher than that in group P at all time points.There was no statistical difference in PaO_2 between the two groups at each time point(P = 0.612),and PaO_2 at t1-t4 was lower than that of the same group(P <0.001).The correlation coefficient between PaCO_2 and PetCO_2 in P group was higher than that in V group at each time point,but the correlation between PaCO_2 and PetCO_2 in the other two groups was lower than that in T0 group. Conclusion: Compared with VCV ventilation,single lung ventilation with PCVVG model can better maintain the correlation between PaCO_2 and PetCO_2. Compared with double lung ventilation,the correlation between PaCO_2 and PetCO_2 in the two ventilation modes are both decreased. In addition,the PCV-VG model can effectively reduce the peak airway pressure and airway plateau pressure and reduce the risk of lung pressure injury while ensuring oxygen supply. It can be safely used in one-lung ventilation after radical resection of esophageal cancer.
引文
[1]王金荣,邵立业等.机械通气患者呼气末二氧化碳分压与动脉血二氧化碳分压的相关性研究[J].中国呼吸与危重监护杂志,2018,17(1):71~75.
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[5] Jens Lohser,Peter Slinger,et al.Lung Injury After One-Lung Ventilation:A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung[J]. Anesthesia&Analgesia,2015,121(2):302~318
[6] Ghabach MB,Elie M EI Hajj,et al.Ventilation of nonparalyzed patients under anesthesia with laryngeal mask airway,comparison of three modes of ventilation:Volume controlled ventilation,pressure controlled ventilation,and pressure controlled ventilation-volume guarantee[J].2017,11(1):197~200.
[7] Song SY,Jung JY,Cho MS,et al.Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation[J]. Korean Anesthesiol,2014,67(4):258~263.
[8] Osama M,Assad MD,et al.Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position[J].Jounrnal of Clinical Anesthesia,(2016),34,55~61.
[9]江飞,金孝岠,刘灿,等.压力控制容量保证通气模式对全麻患者呼吸力学的影响[J].临床麻醉学杂志,2014,30(4):377~379.
[10] Wenjun Liu,Qian Huang,et al. Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection[J].Thoracic Disease,2018,10(5):2760~2770.
[11]李梦怡,李云,胡宪文,等.PCV-VG用于胸腔镜单肺通气患者肺保护性通气的效果[J].中华麻醉学杂志,2017,37(2):155~158.
[2] Blidner AG,Salatino M,Mascsnfroni ID,et al. Different response of myeloid-derived suppressor cells to the nonsteroidal anti-inflammatory agent indomethacin in tumor-associated and tumor-free microenvironments[J]. Immunol,2015,194(7):3452~3462.
[3]高有俊.临床麻醉中呼气末二氧化碳分压监测的临床应用及意义[J].中国实用医药,2017,12(29):70~71
[4] Monu Yadav,Elmati Praveen Reddy,et al.The Effect of Position on PaCO 2 and PETCO 2 in Patients Undergoing Cervical Spine Surgery in Supine and Prone Position[J].Neurosurg Anesthesiol,2017,29(3):298~303.
[5] Jens Lohser,Peter Slinger,et al.Lung Injury After One-Lung Ventilation:A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung[J]. Anesthesia&Analgesia,2015,121(2):302~318
[6] Ghabach MB,Elie M EI Hajj,et al.Ventilation of nonparalyzed patients under anesthesia with laryngeal mask airway,comparison of three modes of ventilation:Volume controlled ventilation,pressure controlled ventilation,and pressure controlled ventilation-volume guarantee[J].2017,11(1):197~200.
[7] Song SY,Jung JY,Cho MS,et al.Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation[J]. Korean Anesthesiol,2014,67(4):258~263.
[8] Osama M,Assad MD,et al.Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position[J].Jounrnal of Clinical Anesthesia,(2016),34,55~61.
[9]江飞,金孝岠,刘灿,等.压力控制容量保证通气模式对全麻患者呼吸力学的影响[J].临床麻醉学杂志,2014,30(4):377~379.
[10] Wenjun Liu,Qian Huang,et al. Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection[J].Thoracic Disease,2018,10(5):2760~2770.
[11]李梦怡,李云,胡宪文,等.PCV-VG用于胸腔镜单肺通气患者肺保护性通气的效果[J].中华麻醉学杂志,2017,37(2):155~158.