肺保护通气及容量控制通气模式应用于单肺通气老年患者术后的效果比较

doi:10.3877/cma.j.issn.1674-6902.2019.06.016

关键词: 通气, 肺保护, 通气模式, 老年患者

表1 两组患者t₀～t₂内呼吸动力学指标对比

组　别		例数	Ppeak(cmH₂O)	Awr(cmH₂O·L^-1·s^-1)	LC(ml·cmH₂O^-1)
LPV组		47
	t₀		60.3±10.3	15.3±3. 3	14.3±2.4
	t₁		43.4±9.6^c	21.3±2.1^c	22.3±3.1^c
	t₂		32.3±8.5^cd	28.8±2.5^cd	28.0±2.6^cd
VCV组		43
	t₀		59.6±11.2^a	15.6±3.2^a	14.5±2.3^a
	t₁		52.4±10.1^bc	19.6±2.9^bc	17.8±2.9^bc
	t₂		46.2±9.3^bcd	23.5±2.6^bcd	21.8±2.1^bcd

表1 两组患者t₀～t₂内呼吸动力学指标对比

组　别		例数	Ppeak(cmH₂O)	Awr(cmH₂O·L^-1·s^-1)	LC(ml·cmH₂O^-1)
LPV组		47
	t₀		60.3±10.3	15.3±3. 3	14.3±2.4
	t₁		43.4±9.6^c	21.3±2.1^c	22.3±3.1^c
	t₂		32.3±8.5^cd	28.8±2.5^cd	28.0±2.6^cd
VCV组		43
	t₀		59.6±11.2^a	15.6±3.2^a	14.5±2.3^a
	t₁		52.4±10.1^bc	19.6±2.9^bc	17.8±2.9^bc
	t₂		46.2±9.3^bcd	23.5±2.6^bcd	21.8±2.1^bcd

表2 两组患者t₀～t₄桡动脉血气分析及脑氧代谢指标对比

组　别		例数	PCO₂(mmHg)	PO₂(mmHg)	SjvO₂(%)	OI(mmHg)	CERO₂(%)
LPV组		47
	t₀		38.6±2.7	93.1±3.3	70.1±3.3	445.1±27.3	28.3±2.3
	t₁		38.8±2.6^a	365.2±53.2^b	67.3±3.2^b	374.1±55.2^b	35.7±3.2^b
	t₂		38.6±1.2^a	251.4±84.1^b	62.2±3.6^b	256.4±83.6^b	42.2±3.9^b
	t₃		38.9±1.3^ac	345.6±57.2^bc	67.4±3.9^bc	365.2±56.9^bc	34.3±1.9^bc
	t₄		38.8±1.1^ac	96.3±4.3^ac	71.5±2.5^ac	431.5±54.5^bc	29.4±1.9^ac
VCV组		43
	t₀		38.8±2.3^d	94.1±3.7^d	70.4±3.5^d	450.1±26.3^d	28.8±2.5^d
	t₁		38.5±2.5^ad	365.9±55.2^bd	67.9±3.4^bd	365.9±54.2^bd	36.1±3.3^bd
	t₂		39.7±1.2^be	175.2±68.1^be	58.3±2.6^be	175.4±68.6^be	39.2±3.9^be
	t₃		38.7±1.7^ad	343.6±56.1^bcd	68.1±2.9^bcd	345.9±57.9^bcd	35.1±2.4^bcd
	t₄		38.3±1.4^ad	95.3±4.7^bcd	70.5±3.7^acd	441.5±64.5^acd	28.6±1.8^acd

表2 两组患者t₀～t₄桡动脉血气分析及脑氧代谢指标对比

组　别		例数	PCO₂(mmHg)	PO₂(mmHg)	SjvO₂(%)	OI(mmHg)	CERO₂(%)
LPV组		47
	t₀		38.6±2.7	93.1±3.3	70.1±3.3	445.1±27.3	28.3±2.3
	t₁		38.8±2.6^a	365.2±53.2^b	67.3±3.2^b	374.1±55.2^b	35.7±3.2^b
	t₂		38.6±1.2^a	251.4±84.1^b	62.2±3.6^b	256.4±83.6^b	42.2±3.9^b
	t₃		38.9±1.3^ac	345.6±57.2^bc	67.4±3.9^bc	365.2±56.9^bc	34.3±1.9^bc
	t₄		38.8±1.1^ac	96.3±4.3^ac	71.5±2.5^ac	431.5±54.5^bc	29.4±1.9^ac
VCV组		43
	t₀		38.8±2.3^d	94.1±3.7^d	70.4±3.5^d	450.1±26.3^d	28.8±2.5^d
	t₁		38.5±2.5^ad	365.9±55.2^bd	67.9±3.4^bd	365.9±54.2^bd	36.1±3.3^bd
	t₂		39.7±1.2^be	175.2±68.1^be	58.3±2.6^be	175.4±68.6^be	39.2±3.9^be
	t₃		38.7±1.7^ad	343.6±56.1^bcd	68.1±2.9^bcd	345.9±57.9^bcd	35.1±2.4^bcd
	t₄		38.3±1.4^ad	95.3±4.7^bcd	70.5±3.7^acd	441.5±64.5^acd	28.6±1.8^acd

1	Marret E, Miled F, Bazelly B, et al. Risk and protective factors for major complications after pneumonectomy for lung cancer[J]. Interact Cardiovasc Thorac Surg, 2010, 10(6): 936-939.
2	Lorusso R, Gelsomino S, Parise O, et al. Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry[J]. Ann Thorac Surg, 2017, 104(1): 62-69. doi: 10.1016/j.athoracsur.
3	Tang L, Kazan R, Taddei R, et al. Reduce cerebraI oxygen saturation during thoracic surgery predicts early postoprative cognitive dysfunction[J]. Br J Anaesth, 20l2, 108(4): 623-629.
4	Wang KY, Yang QY, Tang P, et al. Effects of ulinastatin on early postoperative cognitive function after one-lung ventilation surgery in elderly patients receiving neoadjuvant chemotherapy[J]. Metab Brain Dis, 2017, 32(2): 427-435. doi: 10.1007/s11011-016-9926-7.
5	沈子珒，董　榕. 肺保护通气策略改善易感肺部并发症全身麻醉患者的价值[J]. 上海交通大学学报(医学版), 2015, 35(11): 1632-1635.
6	孙国印，张　媛，蔡丽敏，等. 不同通气模式在老年经腹腔镜直肠癌手术患者中的比较[J]. 中国老年学杂志，2015, 18(35): 5237-5238.
7	Figueroa-Casas JB, Montoya R. Difference in inspiratory flow between volume and pressure control ventilation in patients with flow dyssynchrony[J]. J Crit Care, 42(1): 264-267. doi: 10.1016/j.jcrc.2017.08.007.
8	Leme AC, Hajjar LA, Volpe MS, et al. Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomized Clinical Trial[J]. JAMA, 2017, 317(14): 1422-1432. doi: 10.1001/jama.2017.2297.
9	高明月，杨　珉，况伟宏，等. 简易精神状态量表得分的影响因素和正常值的筛查效度评价[J]. 北京大学学报(医学版), 2015, 47(3): 443-448.
10	Oswald N, Hardman J, Kerr A, et al. Patients want more information after surgery: a prospective audit of satisfaction with perioperative information in lung cancer surgery[J]. J Cardiothorac Surg, 2018, 13(1): 18. doi: 10.1186/s13019-018-0707-8
11	Li SS, Herrick NL, Deshpande RR, et al. The Impact of Residents on Patient Satisfaction[J]. Ann Plast Surg, 2018, 80(5S Suppl 5): S247-S250.
12	Vagvolgyi A, Rozgonyi Z, Kerti M, et al. Effectiveness of perioperative pulmonary rehabilitation in thoracic surgery[J]. J Thorac Dis, 2017, 9(6): 1584-1591.
13	Michelet P, Roch A, Brousse D, et al. Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation[J]. Br J Anaesth, 2005, 95(2): 267-273.
14	方　申. 不同PEEP水平对老年患者单肺通气局部脑氧饱和度的影响[D]. 郑州大学，2017.
15	Kim SH, Jung KT, An TH. Effects of tidal volume and PEEP on arterial blood gases and pulmonary mechanics during one-lung ventilation[J]. J Anesth, 2012, 26(4): 568-573.
16	van IJzendoorn MC, Koopmans M, Strauch U, et al. Ventilator setting in ICUs：comparing a Dutch with a European cohoa[J]. Neth J Med, 2014, 72(9): 473-480.
17	邱晓东，周　晶，叶　卉，等. 术中肺保护性通气策略对开腹手术老年患者术后肺部并发症的影响[J]. 临床麻醉学杂志，2016, 32(1): 28-32.
18	Wang R, Chen J, Wu G. Variable lung protective mechanical ventilation decreases incidence of postoperative delirium and cognitive dysfunction during open abdominal surgery.[J]. Int J Clin Exp Med, 2015, 8(11): 21208-21214.
19	Beard L, Wright CJ. Does non-invasive ventilation confer a lung protective effect and improve long-term pulmonary outcomes？[J]. Acta Paediatr, 2018, 107(6): 1102.
20	rnandez-Bustamante A, Klawitter J, Repine JE, et al. Earlyeffect of tidal volume on lung injury biomarkers in SUrgical patients with healthy lungs[J]. Anesthesiology, 2014, 121(3): 469-481.
21	Robertson CS, Gopinath sP, Goodman JC, et al. SjvO₂ monitoring in head-injured patients[J]. J Neurotrauma, 1995, 12(5): 891-896.
22	Naik BI, Colquhoun DA, Shields IA, et al. Value of the oxygenation index during 1-lung ventilation for predicting respiratory complications after thoracic surgery[J]. J Crit Care, 2017, 37(1): 80-84.
23	Fuller BM, Ferguson IT, Mohr NM, et al. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial[J]. Annals of Emergency Medicine, 2017: S0196064417300288.
24	郭唯真，陈梦媛，高　巨，等. 肺保护性通气对单肺通气老年患者脑氧代谢和术后认知功能的影响[J]. 中华麻醉学杂志，2017, 37(4): 396-399.
25	刘　静，孟志鹏，颜　伟，等. 肺保护性通气策略对腹腔镜胃癌根治手术老年患者肺氧合功能及术后肺部并发症的影响[J]. 临床麻醉学杂志，2019, 35(4): 34-37.
26	Aosasa S, Mochizuki H, Tsujimoto H, et al. Activation of monocytes and endothelial cells depends on the severity of surgical stress[J]. World J Surg, 2000, 24(1): 10-16.
27	Chen C, Zhang Z, Chen T, et al. Prolonged mechanical ventilation-induced neuroinflammation affects postoperative memorydysfunction in surgical mice[J]. Crit Care, 2015, 19: 159.
28	胡继成，柴小青，王　迪，等. 肺保护性通气策略对胸腔镜下肺癌根治术患者免疫功能的影响[J]. 临床麻醉学杂志，2019, 35(1): 10-13.

[1]	徐娟, 孙汝贤, 赵东亚, 张清艳, 金兆辰, 蔡燕. 右美托咪定序贯镇静模式对中深度镇静的机械通气患者预后和谵妄的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 363-369.
[2]	豆艺璇, 黄怀, 钱绮雯, 邢然然, 林丽, 白建芳. 低强度吸气肌训练对机械通气患者肺康复的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 370-375.
[3]	许振琦, 易伟, 范闻轩, 王金锋. 经鼻高流量氧疗与无创机械通气在严重创伤术后轻中度低氧血症患者中的临床应用[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 306-309.
[4]	张芝, 孙海云. 舒适护理对老年腹股沟疝患者腹腔镜手术后睡眠质量及满意度的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 488-490.
[5]	邓美云, 马兰, 胡惠惠. 双环节协同护理模式在老年腹股沟疝患者中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 346-349.
[6]	董艳, 吴向阳, 林巧兰, 李国栋, 杨瑞洲. 基于快速康复外科理念的清单管理在老年双侧腹股沟疝患者围手术期的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 354-358.
[7]	钱晓英, 吴新, 徐婷婷. 颅脑损伤并发呼吸衰竭患者早期机械通气的效果分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 526-528.
[8]	代芬, 卞士柱. 无创机械通气联合肺康复在肺动脉高压呼吸衰竭治疗中的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 560-562.
[9]	程传丽, 曾慧, 周静, 孙凌霞, 吴敏, 钱明江, 陈武, 万洁, 周仁佳. 超声引导下胸肺物理治疗对机械通气患者膈肌功能的疗效分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 563-565.
[10]	饶林静, 罗皓梨, 钟山. 不同时长PPV在体外循环心脏大血管术后并发ARDS中的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 575-577.
[11]	宣瑞萍, 刘笑琴, 王平, 查日田. 无创正压通气与经鼻高流量氧疗治疗AECOPD合并Ⅱ型呼吸衰竭的临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 346-348.
[12]	陈趟, 王艺萱, 吴刚. 单肺通气术中低氧血症与术后肺部并发症的关系及其预测意义[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 355-357.
[13]	吕瑶, 张婵, 陈建华, 张鸣青. 压力控制容量保证通气模式在腹腔镜肝细胞癌切除术中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 528-533.
[14]	李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[15]	卓徐鹏, 刘颖, 任菁菁. 感染性疾病与老年人低蛋白血症的相关性研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 896-899.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Effect of lung protective ventilation and volume control ventilation in the treatment of elderly patients with singlelung ventilation

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Effect of lung protective ventilation and volume control ventilation in the treatment of elderly patients with single­lung ventilation

Effect of lung protective ventilation and volume control ventilation in the treatment of elderly patients with singlelung ventilation