Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland).
Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, Hebei, China (mainland).
Med Sci Monit. 2020 Feb 24;26:e921417. doi: 10.12659/MSM.921417.
BACKGROUND Volume-controlled ventilation (VCV) in one-lung ventilation (OLV) is most commonly used in thoracotomy, but pressure-controlled ventilation-volume guaranteed (PCV-VG) is used in elderly patients to improve arterial oxygenation, reduce inflammatory factors, and decrease acute lung injury (ALI). The purpose of this study was to investigate the effects of these 2 different ventilation modes - VCV versus PCV-VG - during OLV in elderly patients undergoing thoracoscopic lobectomy. MATERIAL AND METHODS Sixty patients undergoing thoracoscopic lobectomy from September 2018 to February 2019 at Cangzhou Central Hospital, Hebei, China were randomly assigned to a VCV group or a PCV-VG group. Pulmonary dynamic compliance (Cdyn), peak inspiratory pressure (PIP), arterial blood gas, and inflammatory factors were monitored to assess lung function. The Clinical Trial Registration Identifier number is ChiCTR1800017835. RESULTS Compared with the VCV group, PIP in the PCV-VG group was significantly lower (P=0.01) and Cdyn was significantly higher at 30 min after one-lung ventilation (P=0.01). MAP of the PCV-VG group was higher than in the VCV group (P=0.01). MAP of the PCV-VG group was also higher than in the VCV group at 30 min after one-lung ventilation (P=0.01). The concentration of neutrophil elastase (NE) in the PCV-VG group was significantly lower than in the VCV group (P=0.01). CONCLUSIONS Compared with VCV, PCV-VG mode reduced airway pressure in patients undergoing thoracotomy and also decreased the release of NE and reduced inflammatory response and lung injury. We conclude that PCV-VG mode can protect the lung function of elderly patients undergoing thoracotomy.
在开胸手术中，单肺通气（OLV）最常采用容量控制通气（VCV），但在老年患者中采用压力控制通气-容量保证（PCV-VG）可以改善动脉氧合，减少炎症因子，降低急性肺损伤（ALI）。本研究旨在探讨在老年患者行电视胸腔镜肺叶切除术中，两种不同通气模式（VCV 与 PCV-VG）在 OLV 中的效果。
2018 年 9 月至 2019 年 2 月，河北沧州中心医院将 60 例行电视胸腔镜肺叶切除术的患者随机分为 VCV 组或 PCV-VG 组。监测肺动态顺应性（Cdyn）、吸气峰压（PIP）、动脉血气和炎症因子，评估肺功能。临床试验注册号为 ChiCTR1800017835。
与 VCV 组相比，PCV-VG 组在单肺通气 30 分钟时 PIP 显著降低（P=0.01），Cdyn 显著升高（P=0.01）。PCV-VG 组的平均动脉压（MAP）高于 VCV 组（P=0.01），PCV-VG 组的 MAP 也高于单肺通气 30 分钟后的 VCV 组（P=0.01）。PCV-VG 组中性粒细胞弹性蛋白酶（NE）浓度显著低于 VCV 组（P=0.01）。
与 VCV 相比，PCV-VG 模式可降低开胸手术患者的气道压力，减少 NE 的释放，减轻炎症反应和肺损伤。我们的结论是，PCV-VG 模式可以保护开胸手术老年患者的肺功能。
