不同通气模式对后腹腔镜手术患者肺损伤的影响

Abstract
Figure/Table
References (20)
Related Citation (15)

Download: PDF (0 KB) HTML (51 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To compare the influence of pressure control ventilation–volume guaranteed (PCV-VG)and volume controlled ventilation (VCV)on lung injury in patients performed with retroperitoneal laparoscopic surgeries.Methods From August to December 2017,60 patients performed with retroperitoneal laparoscopic surgeries in our hospital were selected.They were divided into two groups by a random double-blinding:PCV-VG group (Pgroup)and VCV group (Vgroup)with 30 cases in each group.Ventilation was carried out based on the preset ventilation parameters.At T1-T4(5 min after tracheal intubation,30 min after pneumoperitoneum,90 min after pneumoperitoneum,and 30 min after pneumoperitoneum ending),the Ppeak,Pmean,and end-tidal carbon dioxide(PetCO2)were recorded,lung compliance at various times(Cd)was calculated,and the concentrations of plasma interleukin-6(IL-6),tumor necrosis factor-α (TNF-α),and soluble intercellular cell adhesion molecule-1 (sICAM-1)were monitored at each time by drawing arterial blood.The changes of respiratory mechanics parameters and the concentrations of IL-6,TNF-α and sICAM-1 were compared between the two groups.Results In group P,Pmean,Ppeak,plasma IL-6,TNF-α and sICAM-1 concentrations at T1-T4were significantly lower than those in group V(P＜0.05).In group P,the Cd values at T2,T3,T4were higher than those in group V (P＜0.05).Conclusion The PCV-VG mode can decrease the Ppeak and Pmean in patients undergoing retroperitoneal laparoscopic surgery,increase Cd values,and reduce plasma concentrations of IL-6,TNF-α and sICAM-1,and control the occurrence of lung injury to some extent.

Key words： Pressure control ventilation-volume guaranteed mode Retroperitoneal laparoscopic surgery Lung injury Soluble intercellular cell adhesion molecule-1 Interleukin-6 Tumor necrosis factor-&alpha

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	LA Jin
	TIAN Shou-yuan
	WANG Xin
	SU Xue-sen
	YUAN Xin
	ZHANG Rui
	LIU Shu-fang
	LI Chao

Cite this article:

LA Jin,TIAN Shou-yuan,WANG Xin, et al. Effect of different ventilation modes on lung injury in patients performed with retroperitoneal laparoscopic surgeries[J]. 中国当代医药, 2018, 25(23): 60-63.

URL:

http://dangdaiyiyao.com/EN/ OR http://dangdaiyiyao.com/EN/Y2018/V25/I23/60

[10]	江飞，金孝岠，刘灿，等.压力控制容量保证通气模式对全麻患者呼吸力学的影响[J].中华麻醉学杂志，2014，30（4）：377-379.
[11]	蔡英丽，詹红.呼气末二氧化碳分压联合平台压监测在急性呼吸窘迫综合征机械通气中的应用进展[J].医学综述，2017，23（6）：1210-1214.
[20]	冯丹，姚尚龙，尚游，等.大鼠机械通气所致肺损伤时p38丝裂原活化蛋白激酶通路的激活[J].中国危重病急救医学，2007，19（2）：77-80.
[7]	黄涛，高巨，徐军美.机械通气肺损伤机制及防治新进展[J].医学综述，2014，20（12）：2173-2175.
[8]	罗中兵，张燕辉，黎笔熙，等.侧卧折刀位对动脉血-呼气末二氧化碳分压差的影响[J].国际麻醉学与复苏杂志，2014，35（8）：704-707.
[9]	张岚.后腹腔镜手术不同机械通气模式对血浆CC16及呼吸功能的影响[D].河北：河北医科大学，2014：1-50.
[1]	郁兆存，谭万龙，陈彤，等.后腹腔镜人工CO2气腹对肝、肾功能及心肌酶谱的影响[J].中国微创外科杂志，2007，7（5）： 477-479.
[4]	孙琳婧，杨拥军，唐锦荣，等.后腹腔镜术中降低气腹压力对老年患者呼吸循环的影响[J].临床麻醉学杂志，2012，28（10）：995-997.
[2]	Nickkholgh A，Barro-Bejarano M，Liang R，et al.Signs of reperfusion injury following CO2pneumoperitoneum：an in vivo microscopy study[J].Surg Endosc，2008，22（1）：122-128.
[3]	Karapolat S，Gezer S，Yildirim U，et al.Prevention of pulmonary complications of pneumoperitoneum in rats[J].J Cardiothorac Surg，2011，6（1）：1-7.
[5]	Assad OM，El Sayed AA，Khalil MA.Comparison of volumecontrolled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position[J].J Clin Anesth，2016，34：55-61.
[6]	Ugurlucan M，Basaran M，Erdim F，et al.Pressure-controlled mechanical ventilation is more advantageous in the followup of patients with chronic obstructive pulmonary disease after open heart surgery[J].Heart Surg Forum，2014，17（1）：e1-e6.
[12]	Bellani G，Guerra L，Musch G，et al.Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury[J].Am J Resp CritCare，2011，183（9）：1193-1199.
[13]	Terragni PP，Del Sorbo L，Mascia L，et al.Tidal volume lower than 6 ml/kg enhances lung protection：role of extracorporeal carbon dioxide removal[J].Anesthesiology，2009，111（4）：826-835.
[14]	Amato MBP，Meade MO，Slutsky AS，et al.Driving pressure and survival in the acute respiratory distress syndrome[J].New Engl.J.Med，2015，372（8）：747-755.
[15]	Masood A，Yi M，Lau M，et al.Therapeutic effects of hypercapnia on chronic lung injury and vascular remodeling in neonatal rats[J].Am J Physiol-Lung.C，2009，297（5）： L920-L930.
[16]	Protti A，Cressoni M，Santini A，et al.Lung stress and strain during mechanical ventilation：any safe threshold?[J].Am J Respir Crit Care Med，2011，183（10）：1354-1362.
[17]	Li TS，Zhao B，Wang C，et al.Regulatory effects of hydrogen sulfide on IL-6，IL-8 and IL-10 levels in the plasma and pulmonary tissue of rats with acute lung injury[J].Exp Boil Med，2008，233（9）：1081-1087.
[18]	Kira S，Daa T，Kashima K，et al.Mild hypothermia reduces expression of intercellular adhesion molecule-1 （ICAM-1）and the accumulation of neutrophils after acid-induced lung injury in the rat[J].Acta Anaesthesiologica Scandinavica，2005，49（3）：351-359.
[19]	Donn SM，Sinha SK.Minimising ventilator induced lung injury in preterm infants[J].Arch Dis Child Fetal Neonatal Ed，2006，91（3）：226-230.