不同通气模式结合Autoflow技术在胸科手术中的应用及对呼吸力学的影响

刘晓萌; 王立宪; 牛志强; 单士强; 任蕾; 郭玉峰

doi:10.13898/j.cnki.issn.1000-2200.2023.03.013

不同通气模式结合Autoflow技术在胸科手术中的应用及对呼吸力学的影响

Application of different ventilation modes combined with Autoflow technique in thoracic surgery and its influence on respiratory mechanics

摘要

摘要:
目的探讨对采取胸科手术治疗的病人，采取不同通气模式+Autoflow技术的应用对病人呼吸力学指标的影响。
方法选取2018年12月至2020年6月96例接受胸科手术治疗的肺癌病人，随机分为6组，各16例。A组: 容量控制通气(VCV)潮气量(Vt)5 mL/kg+呼气末正压通气(PEEP)4 mmHg+自动变流(Autoflow)模式；B组: VCV(Vt 5 mL/kg)+PEEP 4 mmHg+恒定送气流速(Constflow)模式；C组: VCV(Vt 5 mL/kg)+PEEP 8 mmHg+ Autoflow模式；D组: VCV(Vt 5 mL/kg)+PEEP 8 mmHg+Constflow模式；E组: VCV(Vt 8 mL/kg)+Autoflow模式；F组: VCV(Vt 8 mL/kg)+Constflow模式。比较各组双肺通气时、通气1 h、通气2 h时气道吸气峰压(APIP)、气道阻力(Raw)、胸顺应性(C)、心率(HR)、平均动脉压(MAP)及动脉血氧分压(PaO₂)水平变化。
结果各组在双肺通气时APIP、Raw、C、HR、MAP及PaO₂各指标水平差异无统计学意义(P>0.05)；通气1 h时，B、E、F组在APIP、Raw上高于A组和C组(P < 0.05)，C组的C值低于其他各组(P < 0.05)，C组PaO₂低于B组(P < 0.05)，其他各组间比较差异均无统计学意义(P>0.05)；通气2 h，B、E、F组在APIP、Raw值上高于A组和C组(P < 0.05)，B组C值低于A组(P < 0.05)，A组和B组PaO₂值低于C组(P < 0.05)，其他各组间比较差异均无统计学意义(P>0.05)；在HR和MAP上，通气1 h和2 h，各组比较差异无统计学意义(P>0.05)。通气1 h和2 h时，C组PaO₂值高于其他各组(P < 0.05)，PaCO₂值均低于其他各组(P < 0.05)。
结论对老年胸部手术治疗的病人，采取VCV(Vt 5 mL/kg)+PEEP 8 mmHg+Autoflow模式可降低气道峰压、阻力，提高动脉血氧分压，有效预防机械通气所致损伤发生。

Abstract:
ObjectiveTo investigate the effects of different ventilation modes + Autoflow technique on respiratory mechanical indexes of patients undergoing thoracic surgery.
MethodsA total of 96 patients with lung cancer treated by thoracic surgery from December 2018 to June 2020 were randomly divided into 6 groups, with 16 cases in each group.Group A: volume-controlled ventilation(VCV) tidal volume(Vt) 5 mL/kg+PEEP 4 mmHg+Autoflow mode; group B: VCV(Vt 5 mL/kg) + PEEP 4 mmHg+Constflow mode; group C: VCV(Vt 5 mL/kg)+PEEP 8 mmHg+Autoflow mode; group D: VCV(Vt 5 mL/kg) +PEEP 8 mmHg+Constflow mode; group E: VCV(Vt 8 mL/kg) +Autoflow mode; group F: VCV(Vt 8 mL/kg)+Constflow mode.The changes of peak inspiratory pressure(APIP), airway resistance(Raw), chest compliance(C), heart rate(HR), mean arterial pressure(MAP) and arterial partial oxygen pressure(PaO₂) were compared in each group at bilateral lung ventilation, ventilation for 1 hour and for 2 hours.
ResultsThere were no statistically significant differences in the levels of APIP, Raw, C, HR, MAP and PaO₂ in each group during bilateral lung ventilation(P>0.05).After 1 hour of ventilation, APIP and Raw in group B, E and F were higher than those in group A and C(P < 0.05), the C value in group C was lower than that in other groups(P < 0.05), the PaO₂ in group C was lower than that in group B(P < 0.05), there was no significant difference among other groups(P>0.05).After 2 hours of ventilation, APIP and Raw in group B, E and F were higher than those in group A and C(P < 0.05), the C value in group B was lower than that in group A(P < 0.05), the PaO₂ value of group A and group B was lower than that in group C(P < 0.05), there was no significant difference among other groups(P>0.05).After ventilation for 1 hour and 2 hours, there was no significant difference in HR and MAP among the groups(P>0.05).
ConclusionsVCV(Vt 5 mL / kg) + PEEP 8 mmHg + Autoflow mode can reduce airway peak pressure and resistance, improve arterial oxygen partial pressure, and effectively prevent injury caused by mechanical ventilation in elderly patients treated by thoracic surgery.

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