PCV中吸气流速对OLV患者呼吸功能及炎症因子的影响

doi:10.3969/j.issn.1000-8535.2020.06.008

广州医药 ›› 2020, Vol. 51 ›› Issue (6): 38-45.DOI: 10.3969/j.issn.1000-8535.2020.06.008

PCV中吸气流速对OLV患者呼吸功能及炎症因子的影响

秦新磊, 殷姜文, 樊世文, 张成超, 张钰, 代志刚

石河子大学医学院第一附属医院麻醉科(石河子 832008)

收稿日期:2020-01-22 出版日期:2020-11-20 发布日期:2021-11-28
通讯作者: 代志刚,E-mail: dzg2009@sina.com
基金资助:
石河子大学科研计划项目(ZZZC201709A)

Effects of different inspiratory velocity during pressure-controlled ventilation on respiratory function and inflammatory factors in patients with one-lung ventilation

QIN Xinlei, YIN Jiangwen, FAN Shiwen, ZHANG Chenchao, ZHANG Yu, DAI Zhigang

Department of Anesthesiology, First Affiliated Hospital,School of Medicine, Shihezi University, Shihezi 832008, China

Received:2020-01-22 Online:2020-11-20 Published:2021-11-28

摘要/Abstract

摘要： 目的比较压力控制通气(PCV)中不同吸气流速对单肺通气(OLV)患者呼吸功能及炎症因子的影响。方法本研究为2018—2019年对75例单肺通气患者的前瞻性研究。患者在麻醉和单肺通气(OLV)后随机分为吸气流量30 L/min(A组)、50 L/min(B组)或70 L/min(C组)。比较OLV前(T₀)、OLV后30 min(T₁)、60 min(T₂)和120 min(T₃)的呼吸力学、呼吸功能、血流动力学和血气分析,中心静脉血检测分析IL- 6、IL-8、TNF-α和sICAM-1,观察术后3天肺部并发症和ARDS的发生情况。结果三组一般情况、血流动力学指标差异均无统计学意义(P＞0.05);B组、C组PaCO₂较A组降低(P<0.05);与T₀时比较,T₁-T₃时三组PaO_2、SVO₂均降低(P<0.05);三组PH、SO₂和HB差异均无统计学意义(P>0.05)。与A组比较,B组、C组ΔVT增大(P<0.05);三组Ppeak差异无统计学意义;与A组比较,B组、C组PEEP均增大(P<0.05);与A组比较,T₁-T₃时B组、C组V_D/V_T减少(P>0.05);与T₀比较,T₁-T₃时三组Qs/Qt增加(P<0.05);与A组比较,T₁-T₃时B组、C组Cdyn增大(P<0.05);与T₀相比,T₁-T₃时三组PaO₂/FiO₂降低(P<0.05);与T₀相比,T₁-T₃时三组IL-6、IL-8、TNF-α和sICAM-1的浓度增多(P<0.05),但A组、B组低于C组(P<0.05)。三组患者发生术后肺部并发症和ARDS差异均无统计学意义。结论在PCV模式下通过增加吸气流速能增加VT,减少死腔率,促进 CO₂的交换,并且改善肺动态顺应性,但并不能很好的改善氧合及肺内分流。吸气流速50 mL/L在较小炎症反应的情况下达到上述改善呼吸功能和呼吸力学,可推荐应用于进行OLV患者。

关键词: 吸气流速, 炎症因子, 压力控制通气, 单肺通气

Abstract: Objective The effects of different inspiratory velocity PCV on respiratory function and inflammatory factors in patients with one-lung ventilation OLV were compared. Methods This was a prospective study of 75 patients with one-lung ventilation in 2018-2019. The subjects were randomized to the inspiratory velocity 30(group A),50(group B)or 70(group C)L/min after anesthesia and one-lung ventilation OLV. Respiratory mechanics,respiratory function,hemodynamics and blood gas parameters were compared between the three groups pre-OLV(T₀)and after 30 (T₁), 60 (T₂), and 120 (T₃)minutes of OLV.Center venous blood was collected to measure interleukin (IL)-6, IL-8,tumor necrosis factor (TNF)-α,andsoluble intercellular adhesion molecule-1 levels.Observation of pulmonary complications and occurrence of ARDS 3 days after operation were made. Results Hemodynamic and general patient status were similar between the three groups (all P>0.05). PaCO₂was lower in the group B and group C compared with the group A (P<0.05). Compared with T₀, PaO₂ and SVO₂were lower at T₁-T₃of the three groups(P<0.05). PH, SO2 and HB were similar between the three groups (all P>0.05).ΔVTwas higher in the group B and group C compared with the group A (P<0.05);Ppeak were similar between the three groups (all P>0.05). PEEPwas higher in the group B and group C compared with the group A (P<0.05); V_D/V_T decreased in the group B and group C compared with the group A (P<0.05).Compared with T₀,Qs/Qt increased at T₁-T₃ of the three groups (all P<0.05). Cdyn increased at T₁-T₃ of the group B and group C(all P<0.05). PaO₂/FiO₂ decreased at T₁-T₃ of the three groups(all P<0.05).Compared with T₀, the concentrations of Il-6, Il-8, TNF-α and sICAM-1 increased at T₁-T₃of three groups (P<0.05), and in group A and group B were lower than those in group C (P<0.05).The number of patients who had postoperative pulmonary complications PPCS or acute respiratory distress syndrome(ARDS)were similar between the three groups (all P>0.05). Conclusion In PCV mode, it can increase VT by increasing the inspiratory velocity, reduce the V_D/V_T, promote the exchange of CO₂, and increase the Cdyn, but it cannot improve the oxygenation and Qs/Qt.Inspiratory velocity of 50 mL/L to achieve the above improvement in respiratory function and respiratory mechanics in the case of a smaller inflammatory response. It may be recommended for use in patients undergoing OLV.

Key words: Inspiratory flow rate, Inflammatory factors, Pressure-controlled ventilation (PCV), One-lung ventilation (OLV)

秦新磊, 殷姜文, 樊世文, 张成超, 张钰, 代志刚. PCV中吸气流速对OLV患者呼吸功能及炎症因子的影响[J]. 广州医药, 2020, 51(6): 38-45.

QIN Xinlei, YIN Jiangwen, FAN Shiwen, ZHANG Chenchao, ZHANG Yu, DAI Zhigang. Effects of different inspiratory velocity during pressure-controlled ventilation on respiratory function and inflammatory factors in patients with one-lung ventilation[J]. Guangzhou Medical Journal, 2020, 51(6): 38-45.

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PCV中吸气流速对OLV患者呼吸功能及炎症因子的影响

Effects of different inspiratory velocity during pressure-controlled ventilation on respiratory function and inflammatory factors in patients with one-lung ventilation

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