南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (07): 1008-1012.doi: 10.12122/j.issn.1673-4254.2020.07.14

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反比通气联合呼气末正压在婴儿肺囊腺瘤术单肺通气中的应用： 63例前瞻性随机对照临床试验

王 昀，黄伟坚，贺牡丹，彭玲莉，蔡明阳，袁 超，胡祖荣，黎昆伟   

  • 出版日期:2020-07-20 发布日期:2020-07-20
  • 基金资助:

Inverse ratio ventilation combined with PEEP in infants undergoing thoracoscopic surgery with one lung ventilation for lung cystadenomas: a randomized control trial of 63 cases

  

  • Online:2020-07-20 Published:2020-07-20

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摘要： 目的 探讨反比通气（IRV）联合呼气末正压（PEEP）对单肺通气（OLV）时肺囊腺瘤术婴儿的影响。方法 选择2018年2月~2019年2月于广东省妇幼保健院择期行胸腔镜下肺囊腺瘤手术单肺通气的婴儿患儿66 例，随机分为常规通气组（N组，n=33）和反比通气组（R组，n=33）。记录双肺通气（TLV）15 min（T）、 l OLV30 min（T2）、OLV60 min（T3）、恢复TLV15 min（T4）患儿的血流动力学和呼吸参数，并进行动脉血气分析。于术前和术后行支气管灌洗，并收集支气管灌洗液，检测晚期糖基化终末产物受体（RAGE）的表达水平。结果 共63例婴儿最终入选。在T2、T3时点，R组Cdyn、PaO2、OI显著高于N组同时间点（P<0.05），气道峰压、动脉二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）显著低于N组同时间点（P<0.05）。T2、T3时间点的HR和MAP两组间比较差异无统计学意义（P>0.05）。两组术后RAGE与同组术前相比都明显增高（P<0.05），而术后与N组相比，R组的RAGE表达水平较低（P<0.05）。结论 合适的IRV联合PEEP应用于胸腔镜下肺囊腺瘤术的OLV婴儿患者，既不影响血流动力学稳定，同时能增加肺顺应性，降低峰压，改善氧合，安全可行，有一定的肺保护作用。

关键词: 反比通气, 呼气末正压, 单肺通气, 婴儿, 肺囊腺瘤

Abstract: Objective To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. Methods A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, n=33) and inverse ventilation group (group R, n=33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T1), OLV30 min (T2), OLV60 min (T3), and 15 min after recovery of TLV (T4). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). Results Sixty-three infants were finally included in this study. At T2 and T3, Cdyn, PaO2 and OI in group R were significantly higher (P<0.05) and Ppeak, PaCO2 and PA-aO2 were significantly lower than those in group N (P< 0.05). There was no significant difference in HR or MAP between the two groups at T2 and T3 (P>0.05). The level of RAGE significantly increased after the surgery in both groups (P<0.05), and was significantly lower in R group than in N group (P< 0.05). Conclusion In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.

Key words: inverse ratio ventilation, positive end-expiratory pressure, one lung ventilation, infants, Pulmonary cystadenoma