Department of Anesthesiology, Shijiazhuang First Hospital, Hebei Medical University , Shijiazhuang, Hebei Province, China.
Respiratory Department, Shijiazhuang First Hospital, Hebei Medical University , Shijiazhuang, Hebei Province, China.
Libyan J Med. 2020 Dec;15(1):1767276. doi: 10.1080/19932820.2020.1767276.
To investigate the effects of inverse ratio ventilation combined with lung-protective ventilation on pulmonary function and inflammatory factors in severe burn patients undergoing surgery. : Eighty patients with severe burns undergoing elective surgery were divided randomly into two groups: control (CG, = 40) and experiment (EG, = 40). The CG had conventional ventilation, whereas the EG were ventilated with tidal volume (TV) of 6-8 ml/kg, I (inspiration): E (expiration) of 2:1, and positive end-expiratory pressure (PEEP) 5 cm H2O. The following variables were evaluated before (T0), 1 h after start of surgery (T1) and after surgery (T2): oxygenation index (OI), partial pressure of carbon dioxide (PaCO), TV, peak airway pressure (Ppeak), mean airway pressure (Pmean), PEEP, pulmonary dynamic compliance (Cdyn), alveolar-arterial difference of oxygen partial pressure D(A-a)O, lactic acid (Lac), interleukin (IL)-6 and IL-10, and lung complications. : At T1 and T2 time points, the OI, Pmean and Cdyn were significantly greater in the EG than in the CG while the TV, Ppeak, D(A-a)O, IL-6 and IL-10 were significantly smaller in the EG than in the CG. At the end of the surgery, the Lac was significantly smaller in the EG than in the CG (1.28 ± 0.19 vs. 1.40 ± 0.23 mmol/L). Twenty-four hours after the surgery, significantly more patients had hypoxemia (27.5 vs. 10.0%), increased expectoration (45.0 vs. 22.5%), increased lung texture or exudation (37.5 vs. 17.5%) in the CG than in the EG. : Inverse ratio ventilation combined with lung-protective ventilation can reduce Ppeak, increase Pmean and Cdyn, improve the pulmonary oxygenation function, and decrease ILs in severe burn surgery patients.
探讨反比通气联合肺保护性通气对择期手术严重烧伤患者肺功能和炎症因子的影响。
将 80 例择期手术的严重烧伤患者随机分为两组：对照组（CG，n=40）和实验组（EG，n=40）。CG 采用常规通气，而 EG 采用 6-8ml/kg 的潮气量（TV）、I（吸气）：E（呼气）比为 2:1 和 5cmH2O 的呼气末正压（PEEP）。在手术前（T0）、手术开始后 1 小时（T1）和手术后（T2）评估以下变量：氧合指数（OI）、二氧化碳分压（PaCO）、TV、气道峰压（Ppeak）、平均气道压（Pmean）、PEEP、肺动态顺应性（Cdyn）、肺泡-动脉氧分压差异（D（A-a）O）、乳酸（Lac）、白细胞介素（IL）-6 和 IL-10 以及肺部并发症。
在 T1 和 T2 时间点，EG 的 OI、Pmean 和 Cdyn 明显大于 CG，而 EG 的 TV、Ppeak、D（A-a）O、IL-6 和 IL-10 明显小于 CG。手术结束时，EG 的 Lac 明显小于 CG（1.28±0.19 vs. 1.40±0.23mmol/L）。手术后 24 小时，CG 较 EG 发生低氧血症（27.5%比 10.0%）、痰液增加（45.0%比 22.5%）、肺纹理或渗出物增加（37.5%比 17.5%）的患者明显更多。
反比通气联合肺保护性通气可降低严重烧伤手术患者的 Ppeak，增加 Pmean 和 Cdyn，改善肺氧合功能，降低 ILs。
