人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用研究

Study on the lung protective ventilation strategy of artificial pneumothorax in full laparoscopic radical resection of esophageal cancer

摘要:

目的 分析人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用效果。方法 选取2021年1月-2023年3月在该院行人工气胸全腔镜食管癌根治术治疗的88例患者作为研究对象，按随机数表法分为两组，每组各44例，对照组采用常规通气模式，实验组采用肺保护性通气策略模式，比较不同通气模式的临床效果。结果 实验组与对照组在气管插管后10 min（T₁）、单肺通气1 h（T₂）、手术完毕时（T₃）和术后24 h（T₄）的pH和二氧化碳分压（PCO₂）比较，差异均无统计学意义（P > 0.05），两组患者T₁、T₂、T₃和T₄时点的氧合指数比较，差异均有统计学意义（P < 0.05）；实验组与对照组T₁、T₂和T₃时点的静态肺顺应性（Cs）、平台压（Pplat）和气道峰压（Ppeak）比较，差异均有统计学意义（P < 0.05）；实验组与对照组T₁时点的C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）和白细胞介素-6（IL-6）水平比较，差异均无统计意义（P > 0.05），两组患者T₂、T₃和T₄时点上述指标比较，差异均有统计学意义（P < 0.05）；对照组肺部并发症发生率为25.00%，高于实验组的9.09%，差异有统计学意义（P < 0.05）。结论 潮气量（VT） 6 mL/kg+100.00%吸入氧浓度+呼气末正压5 cmH₂O+肺复张的肺保护性通气策略，用于人工气胸全腔镜食管癌根治术中，能够明显降低术中气道压力，减轻炎症反应，提高通气安全性。

Abstract:

Objective To explore the effect of lung protective ventilation strategy in artificial pneumothorax in full laparoscopic radical resection of esophageal cancer.Methods 88 patients were selected from January 2021 to March 2023 for the treatment of artificial pneumothorax with full laparoscopic radical resection of esophageal cancer. They were randomly divided into two groups. 44 patients underwent conventional ventilation as the control group, and 44 patients underwent lung-protective ventilation strategy as the experimental group, and the different effects produced by the above different ventilation modes were analyzed.Results There were no significant differences in pH and partial pressure of carbon dioxide (PCO₂) between the experimental group and the control group at the 10 min after endotracheal intubation (T₁), 1 h after single lung ventilation (T₂), after surgery (T₃), and 24 h after surgery (T₄) (P > 0.05). The oxygenation index at the time points of T₁, T₂, T₃ and T₄, there were significant differences between the two groups (P < 0.05). The experimental group and the control group had significant differences in static lung compliance (Cs), plateau pressure (Pplat), and peak airway pressure (Ppeak) at the T₁, T₂, and T₃ time points (P < 0.05). At T₁, there were no significant differences in the levels of C-reaction protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and interleukin-6 (IL-6) between the experimental group and the control group at the time points (P > 0.05). There were significant differences of the above indicators between the two groups at T₂, T₃, and T₄ time points (P < 0.05); The incidence of pulmonary complications was 25.00% in the control group compared with 9.09% in the experimental group, there was a significant difference (P < 0.05).Conclusion Tidal volume (VT) 6 mL/kg + 100.00% inhaled oxygen concentration+positive end-expiratory pressure 5 cmH₂O + recruitment lung protective ventilation strategy used in artificial pneumothorax for full laparoscopic radical resection of esophageal cancer can significantly reduce intraoperative airway pressure and inhibit inflammatory reaction and increase ventilation safety.