PRVC模式在肺叶切除术中单肺通气时的应用

王　芸; 缪长虹; 许平波

doi:10.3969/j.issn.1007-3969.2015.09.006

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PRVC模式在肺叶切除术中单肺通气时的应用

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- PRVC模式在肺叶切除术中单肺通气时的应用
- Application of PRVC ventilation mode in one-lung ventilation during pulmonary lobectomy
- 中国癌症杂志 2015年25卷第9期页码：677-682
- 作者机构：
  
  复旦大学附属肿瘤医院麻醉科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2015.09.006
  中图分类号：
- 网络出版：2015-12-15，
  
  纸质出版：2015-12-15
- 稿件说明：
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王　芸,缪长虹,许平波. PRVC模式在肺叶切除术中单肺通气时的应用[J]. 中国癌症杂志, 2015, 25(9): 677-682.

王　芸, 缪长虹, 许平波. Application of PRVC ventilation mode in one-lung ventilation during pulmonary lobectomy[J]. China Oncology, 2015, 25(9): 677-682.
王　芸,缪长虹,许平波. PRVC模式在肺叶切除术中单肺通气时的应用[J]. 中国癌症杂志, 2015, 25(9): 677-682. DOI： 10.3969/j.issn.1007-3969.2015.09.006.

王　芸, 缪长虹, 许平波. Application of PRVC ventilation mode in one-lung ventilation during pulmonary lobectomy[J]. China Oncology, 2015, 25(9): 677-682. DOI： 10.3969/j.issn.1007-3969.2015.09.006.

摘要

背景与目的：部分拟行肺叶切除术的患者术前可能存在明显的通气功能障碍，术中单肺通气时如采用容量控制(volume-controlled，VC)通气模式可能会诱发肺损伤。压力调节容量控制(pressure-regulated volume controlled，PRVC)通气模式是一新型通气模式，可减少呼吸机相关肺损伤的发生。本研究拟探讨肺叶切除术中单肺通气时应用PRVC模式对患者气道压、氧合指数、肺内炎症指标以及预后的影响。方法：采用随机数字表法将40例ASA Ⅱ~Ⅲ、术前检查提示肺功能中-重度障碍、择期行肺叶切除术的患者随机分为VC组和PRVC组，每组20例。单肺通气期间，VC组先采用PRVC模式通气5 min，而后转为VC模式通气；而PRVC组则先采用VC模式通气5 min，然后再转为PRVC模式通气，直至手术结束。更改模式时不改变呼吸机参数。记录两组患者在不同通气模式下的气道峰压、气道平台压、肺静态顺应性、血气分析结果以及血流动力学的变化。单肺通气结束时，收集患者通气侧肺肺泡灌洗液(bronchoalveolar lavage fluid，BALF)以及血清学标本，分别测量TNF-α、IL-1β、IL-6和IL-8，记录患者术后肺部并发症情况及住院时间。结果：与VC模式相比，应用PRVC模式后气道压明显降低(P0.01)，肺静态顺应性明显升高(P0.05)，但两组间术中血气分析结果、血流动力学参数以及术后肺部并发症方面差异无统计学意义(P0.05)。PRVC组患者BALF中TNF-α、IL-1β和IL-6水平均明显低于VC组(P0.05)，但两组患者血清学炎症因子水平差异无统计学意义(P0.05)。结论：对于术前肺功能不佳的拟行肺叶切除术的患者，术中单肺通气期间采用PRVC通气模式可有效降低气道压、减少肺内炎症因子的分泌，是一种安全有效的保护性通气模式。

Abstract

Background and purpose: Obvious pulmonary dysfunction may exsist preoperatively in part of the patients undergoing pulmonary lobectomy. Volume-controlled ventilation (VC) during one-lung ventilation (OLV) may lead to lung injury in lung cancer patients with preoperative pulmonary dysfunction. However

pressure-regulated volume-controlled (PRVC) ventilation mode is a new type of ventilation mode

and can alleviate ventilation-induce

d lung injury. This study explored the effect of PRVC on respiratory mechanics

oxygenation index

pulmonary inflammatory response

and clinical outcomes in patients undergoing pulmonary lobectomy during OLV compared with VC mode. Methods: Forty ASA Ⅱ-Ⅲ patients with moderate to severe pulmonary dysfunction undergoing pulmonary lobectomy were randomly divided into group VC and group PRVC (n=20)．PRVC ventilation mode was performed for patients in group VC during the first 5 minutes after OLV

and then ventilation mode was switched to VC ventilation mode till the end of surgery. In the other group

ventilation modes were performed in reverse order. Ventilation settings remained unchanged when ventilation mode was switched. Respiratory mechanics

static lung compliance

hemodynamic parameters and arterial blood gas were obtained during the surgery. Blood samples and bronchoalveolar lavage (BALF) in ventilated lung were collected to determine the level of TNF-α

IL-1β

IL-6 and IL-8 at the end of surgery. Results: Both the peak expiratory pressure and static lung compliance in group PRVC were significantly lower than those in group VC (P0.01). However

there were no statistical difference in hemodynamic parameters (heart rate and blood pressure) and arterial blood gas analysis (pH

paO

and paCO

) between the two groups during OLV

as well as postoperative pulmonary complications and length of hospital stay. The levels of TNF-α

IL-1β and IL-6 in BALF in group PRVC were significantly lower than those in group VC (P0.05)

while there was no difference in blood sample. Conclusion: PRVC mode during OLV may relieve the extravagant airway pressure and then reduce the release of inflammatory factors in ventilation lung

which might prevent acute lung injury induced by lung barotraumas

especially for those patients with pulmonary dysfunction preoperatively. Therefore

PRVC mode is a safe and effective ventilation mode for high-risk patients undergoing pulmonary lobectomy.

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