保护性通气策略对于开胸术后肺损伤的影响

目的 评价单肺通气（OLV）期间个体化保护性通气策略的应用对于开胸术后肺损伤的影响。方法 32例限期进行肺切除手术的患者随机分为两组。常规通气组（TG）：潮气量8mL／kg，吸气峰压（PIP）小于30cmH2O；保护性通气组（PG）：潮气量1／2VT（为患者术前肺功能潮气量测试值减半），PIP〈25cmH2O。在全麻平卧位双肺通气20min后（T1）和手术结束（T2）两个时间点收集动脉血做血气分析，记录患者各时点PaO2，PaCO2，pH．FiO2等数据，并据此计算出氧合指数（OI）。同时收集静脉血测量血浆中IL-6水平。结果 无论常规通气组还是保护性通气组，术后氧合指数较术前均有明显降低；术后血浆IL-6浓度较术前明显升高（P〈0．05）。这种变化在保护性通气组与常规通气组之间没有统计学意义（P〉0．05）。与常规通气模式相比，保护性通气策略明显减轻高体重（超过标准体重10kg以上）患者术后氧合指数的降低（P〈0．05）。结论 OLV期间，个体化保护性通气策略可减轻高体重患者术后肺损伤程度。

Effect of protective ventilation on postoperative lung injury during one-lung ventilation

[Objective] To evaluate the efficacy of individual protective ventilation strategy on the postoperative lung injury during one-lung ventilation (OLV). [Methods] Thirty-two patients undergoing pulmonary resection were randomly divided into two groups. Traditional ventilation group (TG): tidal volume 8 mL/kg and peak inspiratory pressure (PIP) <30 cmH2O. Protective ventilation group (PG): tidal volume 1/2VT (half-tidal-volume from preoperative pulmonary function test) and PIP<25 cmH2O. The arterial blood samples were collected for blood gases analysis immediately 20 minutes after two-lung ventilation (TLV) in the supine position after anesthesia (T1) and the end of operation (T2). The values of PaO2, PaCO2, pH and the inspired oxygen fraction (FiO2) were recorded and the values of oxygenation index (OI) were calculated respectively. The venous blood samples were collected for measurement of plasma interleukin-6 (IL-6) level at two time points. [Results] In all the patients, a decrease in OI and increase in plasma IL-6 level occurred at the end of operation (P <0.05). There were no significant differences of changes between the TG and the PG (P >0.05). For the overweight patients (difference between body weight and predicted body weight higher 10 kg), the decreases in OI were larger in traditional ventilation strategy than those in protective ventilation strategy (P <0.05). [Conclusion] During OLV, the individual protective ventilation strategy moderates the postoperative lung injury for the overweight patients.