保护性肺通气对电视胸腔镜外科手术患者术后谵妄和恢复的影响*

Effects of protective lung ventilation on postoperative delirium and recovery in patients with lung cancer undergoing thoracoscopic surgery*

摘要:

目的 研究保护性肺通气（PLV）对电视胸腔镜外科手术（VATS）患者术后谵妄（POD）及恢复的影响。方法 将100例择期VATS下肺癌根治术的患者，随机分为保护性肺通气组（PPV组）52例和传统肺通气组（CPV组）48例。PPV组双肺通气设置：潮气量（VT）8?ml/kg+呼吸末正压（PEEP）5?cmH2O，吸入氧浓度（FIO2）0.7；单肺通气（OLV）设置：VT 6 mg/kg+PEEP 5?cmH2O+肺复张[持续肺充气法：3～5?s内将气道峰压（Ppeak）升到30?cmH2O，持续30?s恢复原状，重复3次]，FIO2 0.7。CPV组双肺通气设置：VT 10?ml/kg，FIO2 1.0；OLV设置：VT 8?ml/kg，FIO2 1.0。两组吸呼比=1∶2，调整呼吸频率维持呼吸末二氧化碳分压（PETCO2）35～45?mmHg。通过脑氧饱和度（rSO2）监测脑氧合情况，同时监测术中氧分压（PaO2）和氧合指数（OI）；术后每天随访，采用意识错乱评估法（CAM）判定是否发生POD，并记录术后肺部并发症（PPCs）和术后恢复情况。结果 PPV组术中PaO2、OI高于CPV组（P?<0.05）；rSO2发生率低于CPV组（P?<0.05）；POD和PPCs发生率低于CPV组（P?<0.05）；且PPV组术后气管导管拔出时间、下床活动时间及引流管拔出时间缩短（P?<0.05）。结论 PLV提高VATS患者机械通气时血氧饱和度和rSO2，降低POD发生率；并且降低PPCs发生率，加速患者术后恢复。

Abstract:

Objective To study the effects of protective lung ventilation (PLV) strategy on postoperative delirium (POD) and recovery in patients undergoing video-assisted thoracic surgery (VATS). Methods One-hundred patients undergoing elective VATS lung cancer were randomized into a protective pulmonary ventilation group (52 patients in the PPV group) and a conventional pulmonary ventilation group (48 patients in the CPV group). Double lung ventilation was set in the PPV group: VT 8?ml/kg+PEEP 5?cmH2O, FIO2 0.7; during one lung ventilation setting, VT 6?mg/kg+PEEP 5?cmH2O+lung recruitment (continuous lung inflation method, (Ppeak) is raised to 30?cmH2O within 3 to 5?s, and remains unchanged for 30?s, repeated 3 times), FIO2 0.7 were set; double lung ventilation, VT 10?ml/kg, FIO2 1.0, and one lung ventilation setting, VT 8?ml/kg, FIO2 1.0, were set in CPV group. The two groups had a respiratory ratio of 1 : 2 and adjusted the respiratory rate to maintain end-tidal partial pressure of carbon dioxide PETCO2 from 35 to 45 mmHg. Cerebral oxygen saturation (rSO2) was used to monitor cerebral oxygenation; at the same time, intraoperative partial pressure of oxygen (PaO2) and oxygenation index (OI) were monitored. Patients were followed up for daily after surgery. The conscious disorder assessment (CAM) was used to determine whether postoperative delirium (POD) occurred or not. And postoperative pulmonary complications (PPCs) and postoperative recovery were recorded. Results The incidence of PaO2 and OI in the PPV group was higher than that in the CPV group (P?