Wang Lei,Xiao Ting,Du Zhen,et al.Effect of pressure-controlled ventilation-volume guaranteed mode on preschool children undergoing thoracic surgery:a randomized controlled study[J].Journal of Clinical Pediatric Surgery,2024,(12):1166-1173.[doi:10.3760/cma.j.cn101785-202409055-011]
压力控制通气-容量保证模式对学龄前胸外科手术患儿的影响:一项随机对照研究
- Title:
- Effect of pressure-controlled ventilation-volume guaranteed mode on preschool children undergoing thoracic surgery:a randomized controlled study
- Keywords:
- Thoracic Surgery; Pulmonary Ventilation; Methods; One-Lung Ventilation; Respiration; Artificial; Postoperative Complications; Lung; Treatment Outcome; Child; Preschool
- 摘要:
- 目的 对学龄前胸外科手术患儿应用压力控制通气-容量保证模式进行效果观察,评估该通气模式对于患儿术后肺部并发症、氧合情况以及呼吸机相关肺损伤的影响。方法 本研究为前瞻性随机对照试验,按照一定纳入与排除标准收集71例接受胸外科手术的学龄前患儿作为研究对象。将患儿通过计算机生成的分配方案以1[KG0.5mm]∶[KG-1mm]1比例进行随机分组,分为压力控制通气-容量保证组(pressure-controlled ventilation-volume guaranteed,PCV-VG组,n=36)和常规容量控制通气组(volume-controlled ventilation,VCV组,n=35)。所有患儿围手术期通气方案遵从肺保护通气策略,PCV-VG组设定为PCV-VG通气模式,VCV组设定为VCV通气模式。主要观察指标为术后72 h以内肺部并发症发生率。次要观察指标包括术中呼吸力学指标、血气分析结果、循环监测结果,以及机械通气时间、住院时间等。结果 PCV-VG组术后肺部并发症发生率(3/36,8.3%)显著低于VCV组(10/35,28.6%,P=0.035),差异具有统计学意义。相较于VCV组,PCV-VG组单肺通气(one-lung ventilation,OLV)期间气道峰压[OLV 30 min:20(18,22)cmH2O比25(23,27)cmH2O,OLV结束:17(15,18)cmH2O比20(18,22)cmH2O,P<0.001]更低,呼吸阻力(OLV 30 min:48.7±10.3比60.5±13.3,P=0.027)更低,胸肺顺应性[OLV 30 min:6.0(4.0,7.0)mL/cmH20比5.0(4.0,6.0)mL/cmH20,P=0.021;OLV结束:8(7.0,9.0)mL/cmH20比7(6.0,8.0)mL/cmH2O,P=0.041]更好。此外,PCV-VG组氧合情况[OLV 30 min:136.4(120.4,165.0)mmHg;OLV结束:190.2(179.3,202.2)mmHg]显著优于VCV组[OLV 30 min:100.0(89.4,137.5)mmHg;OLV结束:176.8(142.1,189.8)mmHg](P>0.05),术后机械通气时间(97.5(70.0,137.5)min比120(95.0,140.0)min,P=0.040)和住院时间[7(5,9)d比8(7,15)d,P=0.024]更短。结论 压力控制通气-容量保证模式在学龄前胸外科手术患儿中应用,可显著降低术后肺部并发症的发生率,降低单肺通气期间气道压力、改善氧合情况。PCV-VG模式可作为此类手术的优选机械通气方式。
- Abstract:
- Objective This study aims to evaluate the effect of the pressure-controlled ventilation-volume guaranteed (PCV-VG) mode on postoperative pulmonary complications,oxygenation,and ventilator-associated lung injury in preschool children undergoing thoracic surgery. Methods This prospective randomized controlled trial included 71 preschool children undergoing thoracic surgery between April 2020 and June 2021.Participants were randomized in a 1:1 ratio using a computer-generated allocation scheme into the PCV-VG group (n=36) and the conventional volume-controlled ventilation (VCV) group (n=35).All perioperative ventilation followed lung-protective ventilation strategies,with the PCV-VG group receiving PCV-VG mode and the VCV group receiving VCV mode.The primary outcome was the incidence of pulmonary complications within 72 hours postoperatively.Secondary outcomes included intraoperative respiratory mechanics,arterial blood gas analysis,circulatory parameters,mechanical ventilation duration,and hospital stay. Results The incidence of postoperative pulmonary complications in the PCV-VG group (3/36,8.3%) was significantly lower than that in the VCV group (10/35,28.6%,P=0.035).During one-lung ventilation (OLV),the PCV-VG group demonstrated significantly lower peak airway pressure [OLV 30 minutes:20 (18,22) cmH2O vs.25 (23,27) cmH2O; end of OLV:17 (15,18) cmH2O vs.20 (18,22) cmH2O;P<0.001]and lower respiratory resistance [OLV 30 minutes:48.7±10.3 vs.60.5±13.3;P=0.027],along with better lung compliance [OLV 30 minutes:6.0 (4.0,7.0) mL/cmH2O vs.5.0 (4.0,6.0) mL/cmH2O; P=0.021; end of OLV:8 (7.0,9.0) mL/cmH2O vs.7 (6.0,8.0) mL/cmH2O; P=0.041].Oxygenation in the PCV-VG group was also superior to the VCV group [OLV 30 minutes:136.4 (120.4,165.0) mmHg vs.100.0 (89.4,137.5) mmHg; end of OLV:190.2 (179.3,202.2) mmHg vs.176.8 (142.1,189.8) mmHg,P<0.05].Additionally,the PCV-VG group had shorter postoperative mechanical ventilation duration [97.5 (70.0,137.5) minutes vs.120 (95.0,140.0) minutes; P=0.040]and hospital stay [7 (5,9) days vs.8 (7,15) days; P=0.024]. Conclusions The PCV-VG mode significantly reduces postoperative pulmonary complications,lowers airway pressure during OLV,and improves oxygenation in preschool children undergoing thoracic surgery.PCV-VG can be considered the preferred mechanical ventilation strategy for such procedures.
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备注/Memo
收稿日期:2024-9-22。
基金项目:湖南省自然科学基金资助项目(2023JJ30325、2019JJ50295)
通讯作者:屈双权,Email:shuangquanqu@126.com