Ahn H J, Kim J A, Yang M, Shim W S, Park K J, Lee J J
Department of Anesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Anaesth Intensive Care. 2012 Sep;40(5):780-8. doi: 10.1177/0310057X1204000505.
Recent papers suggest protective ventilation (PV) as a primary ventilation strategy during one-lung ventilation (OLV) to reduce postoperative pulmonary morbidity. However, data regarding the advantage of the PV strategy in patients with normal preoperative pulmonary function are inconsistent, especially in the case of minimally invasive thoracic surgery. Therefore we compared conventional OLV (VT 10 ml/kg, FiO2 1.0, zero PEEP) to protective OLV (VT 6 ml/kg, FiO2 0.5, PEEP 5 cmH2O) in patients with normal preoperative pulmonary function tests undergoing video-assisted thoracic surgery. Oxygenation, respiratory mechanics, plasma interleukin-6 and malondialdehyde levels were measured at baseline, 15 and 60 minutes after OLV and 15 minutes after restoration of two-lung ventilation. PaO2 and PaO2/FiO2 were higher in conventional OLV than in protective OLV (P<0.001). Interleukin-6 and malondialdehyde increased over time in both groups (P<0.05); however, the magnitudes of increase were not different between the groups. Postoperatively there were no differences in the number of patients with PaO2/FiO2<300 mmHg or abnormalities on chest radiography. Protective ventilation did not provide advantages over conventional ventilation for video-assisted thoracic surgery in this group of patients with normal lung function.
近期的论文表明，保护性通气（PV）作为单肺通气（OLV）期间的主要通气策略，可降低术后肺部并发症。然而，关于PV策略在术前肺功能正常患者中的优势的数据并不一致，尤其是在微创胸外科手术中。因此，我们在接受电视辅助胸外科手术且术前肺功能测试正常的患者中，将传统OLV（潮气量10 ml/kg，吸入氧浓度1.0，呼气末正压为零）与保护性OLV（潮气量6 ml/kg，吸入氧浓度0.5，呼气末正压5 cmH₂O）进行了比较。在OLV后15分钟、60分钟以及双肺通气恢复后15分钟时测量氧合、呼吸力学、血浆白细胞介素-6和丙二醛水平。传统OLV组的动脉血氧分压（PaO₂）和PaO₂/吸入氧浓度（PaO₂/FiO₂）高于保护性OLV组（P<0.001）。两组中白细胞介素-6和丙二醛水平均随时间升高（P<0.05）；然而，两组升高幅度无差异。术后，PaO₂/FiO₂<300 mmHg的患者数量或胸部X线异常情况在两组间无差异。在这组肺功能正常的患者中，对于电视辅助胸外科手术，保护性通气并不优于传统通气。
