保护性机械通气在肺癌胸腔镜肺段切除术中的临床应用

doi:10.3877/cma.j.issn.1674-6902.2024.04.011

目的

分析肺癌胸腔镜肺段切除术中保护性机械通气(protective mechanical ventilation, PMV)的临床应用效果。

方法

选取2023年1月至2024年1月我院收治的行胸腔镜肺段切除术肺癌患者68例为对象，常规机械通气35例为对照组，保护性机械通气33例为观察组。比较两组术中单肺通气15 min、60 min平台压和气道峰压，术前、术后动脉氧分压(arterial oxygen partial pressure, PaO₂)、第一秒用力呼气量(forced expiratory volume in first second, FEV₁)、用力通气量(forced expiratory volume, FVC)、每分钟最大通气量(maximal voluntary ventilation, MVV)，动态顺应性(compliance of dynamic, Cd)和静态顺应性(compliance of static, Cs)，丙二醛(malondialdehyde, MDA)、超氧化物歧化酶(superoxide dismutase, SOD)及生活质量。

结果

术中观察组平台压单肺通气15 min(16.00±3.00) cmH₂O、60 min(13.00±3.00)cmH₂O和气道峰单肺通气15 min(20.00±4.00) cmH₂O、60 min(16.00±3.00 )cmH₂O低于对照组平台压单肺通气15 min(20.00±4.00 )cmH₂O、60 min(19.00±2.00)cmH₂O，气道峰压单肺通气15 min(27.00±4.00) cmH₂O、60 min(25.00±3.00) cmH₂O(P<0.05)。术后两组PaO₂、FEV₁、FVC和MVV下降(P<0.05)，观察组PaO₂(78.31±5.22 )mmHg、FEV₁(1.13±0.42)L、FVC(2.18±0.51)L和MVV(92.34±4.26)L高于对照组PaO₂(61.23±6.27)mmHg、FEV₁(0.96±0.51)L、FVC(2.02±0.32)L和MVV(90.17±3.45)L(P<0.05)；术后两组Cd和Cs升高(P<0.05)，观察组Cd(41.00±5.00)和Cs(128.00±32.00)高于对照组Cd(38.00±5.00)和Cs(113.00±43.00)(P<0.05)；两组术后SOD较术前下降，MDA较术前升高(P<0.05)，观察组SOD(74.32±6.57)U/ml高于对照组SOD(70.32±5.46)U/ml，MDA(4.87±0.66)nmol/ml低于对照组(5.24±0.68)nmol/ml(P<0.05)。术后观察组生活质量评分高于对照组(P<0.05)。

结论

肺癌胸腔镜肺段切除术中采用保护性机械通气可有效改善肺功能，减轻氧化应激反应具有临床意义。

关键词: 支气管肺癌, 保护性机械通气, 胸腔镜肺切除术, 肺功能, 氧化应激, 生活质量

Objective

To analyze the clinical effect of protective mechanical ventilation (PMV) in thoracoscopic segmentectomy for lung cancer.

Methods

A total of 68 patients with lung cancer who underwent thoracoscopic segmental resection in our hospital from January 2023 to January 2024 were selected as the subjects, 35 patients with conventional mechanical ventilation as the control group, and 33 patients with protective mechanical ventilation as the observation group. The intraoperative single lung ventilation platform pressure and peak airway pressure were compared between the two groups for 15 min and 60 min. It was compared that reoperative and postoperative arterial oxygen partial pressure (PaO₂), forced expiratory volume in first second (FEV₁), forced expiratory volume, FVC), maximal voluntary ventilation (MVV) per minute, compliance of dynamic (Cd) and compliance of static (Cs), malondialdehyde (MDA), superoxide dismutase (SOD) and life quality level.

Results

In the observation group, platform pressure single lung ventilation for 15min (16.00±3.00) cmH₂O, 60min(13.00±3.00) cmH₂O and airway peak single lung ventilation for 15 min (20.00±4.00) cmH₂O, 60 min(16.00±3.00) cmH₂O were lower than that of the control group 15 min (20.00±4.00) cmH₂O, 60min (19.00±2.00) cmH₂O, Airway peak pressure single lung ventilation for 15 min (27.00±4.00) cmH₂O and 60min (25.00±3.00)cmH₂O (P<0.05). PaO₂, FEV₁, FVC and MVV decreased in two groups after operation (P<0.05). Observation group PaO₂ (78.31±5.22)mmHg, FEV₁ (1.13±0.42)L, FVC (2.18±0.51)L and MVV (92.34±4.26)L were higher than PaO₂(61.23±6.27)mmHg, FEV₁ (0.96±0.51)L, FVC (2.02±0.32) L and MVV (90.17±3.45)L in the control group (P<0.05); The levels of Cd and Cs in the observation group were higher (41.00±5.00) and Cs (128.00±32.00) than those in the control group (38.00±5.00) and Cs (113±43) (P<0.05). SOD (74.32±6.57) U/ml in the observation group was higher than that in the control group (70.32±5.46) U/ml. The MDA (4.87±0.66) nmol/ml was lower than that of the control group (5.24±0.68) nmol/ml (P<0.05). The life quality score of the observation group was higher than that of the control group (P<0.05).

Conclusion

Protective mechanical ventilation in thoracoscopic segmental resection of lung cancer can effectively improve lung function, it has clinical significance.

Key words: Bronchial lung cancer, Protective mechanical ventilation, Thoracoscopic pneumonectomy, Lung function, Oxidative stress, Quality of life

表1 两组肺癌患者术中通气平台压和气道峰压比较

组　别	例数	平台压(cmH₂O)		气道峰压(cmH₂O)
组　别	例数	单肺通气15 min	单肺通气60 min	单肺通气15 min	单肺通气60 min
观察组	33	16.00±3.00	13.00±3.00	20.00±4.00	16.00±3.00
对照组	35	20.00±4.00	19.00±2.00	27.00±4.00	25.00±3.00
t值		4.345	4.762	5.264	5.638
P值		0.038	0.034	0.030	0.027

表1 两组肺癌患者术中通气平台压和气道峰压比较

组　别	例数	平台压(cmH₂O)		气道峰压(cmH₂O)
组　别	例数	单肺通气15 min	单肺通气60 min	单肺通气15 min	单肺通气60 min
观察组	33	16.00±3.00	13.00±3.00	20.00±4.00	16.00±3.00
对照组	35	20.00±4.00	19.00±2.00	27.00±4.00	25.00±3.00
t值		4.345	4.762	5.264	5.638
P值		0.038	0.034	0.030	0.027

表2 两组肺癌患者肺氧合功能结果比较

组　别	例数	FEV₁(L)		FVC(L)		MVV(L)		PaO₂(mmHg)
组　别	例数	术前	术后3 h	术前	术后3 h	术前	术后3 h	术前	术后3 h
观察组	33	1.58±0.31	1.13±0.42	2.28±0.42	2.18±0.51	95.05±3.42	92.34±4.26	87.02±5.36	78.31±5.22
对照组	35	1.59±0.32	0.96±0.51	2.29±0.37	2.02±0.32	94.86±4.24	90.17±3.45	86.93±6.12	61.23±6.27
t值		0.476	4.387	0.482	2.836	0.486	4.251	0.532	5.632
P值		0.673	0.037	0.662	0.046	0.727	0.040	0.627	0.027

表2 两组肺癌患者肺氧合功能结果比较

组　别	例数	FEV₁(L)		FVC(L)		MVV(L)		PaO₂(mmHg)
组　别	例数	术前	术后3 h	术前	术后3 h	术前	术后3 h	术前	术后3 h
观察组	33	1.58±0.31	1.13±0.42	2.28±0.42	2.18±0.51	95.05±3.42	92.34±4.26	87.02±5.36	78.31±5.22
对照组	35	1.59±0.32	0.96±0.51	2.29±0.37	2.02±0.32	94.86±4.24	90.17±3.45	86.93±6.12	61.23±6.27
t值		0.476	4.387	0.482	2.836	0.486	4.251	0.532	5.632
P值		0.673	0.037	0.662	0.046	0.727	0.040	0.627	0.027

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Clinical application of protective mechanical ventilation in thoracoscopic segmentectomy for lung cancer

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Clinical application of protective mechanical ventilation in thoracoscopic segmentectomy for lung cancer