Analysis of the effect of high-frequency ventilation with low tidal volume on the affected side of the lung during one lung ventilation in thoracoscopic lobectomy
单肺通气时辅助患侧肺小潮气量高频率通气模式在胸腔镜肺叶切除术的效果分析

摘要

目的 分析单肺通气时辅助患侧肺小潮气量高频率通气模式在胸腔镜肺叶切除术的效果。方法 将2020年2月-2021年2月行胸腔镜肺叶切除术的96例患者纳入研究，随机分为实验组与参考组，每组48例。术中，实验组在单肺通气时辅助患侧肺小潮气量高频率通气模式，参考组在单肺通气时选择常规通气模式，观察两组各时间点[全麻插管后双肺通气时（T0）、单肺通气1h（T1）、单肺通气4h（T2）]的血流动力学指标[动脉二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）]、炎性细胞因子[白细胞介素-10（IL-10）、白细胞介素-8（IL-8）]水平与机械通气相关性肺损伤（VILI）发生率。结果 T0时间点，两组患者的血流动力学指标与炎性细胞因子水平无明显差异（P＞0.05）；T1、T2时间点，两组患者的血流动力学指标与炎性细胞因子水平均上升，其中实验组PaCO2、PaO2高于参考组，IL-10、IL-8低于参考组，有明显差异（P＜0.05）；实验组VILI发生率低于参考组，有明显差异（P＜0.05）。结论 单肺通气时辅助患侧肺小潮气量高频率通气模式在胸腔镜肺叶切除术的效果令人满意，有利于维持术中血流动力学稳定，减轻炎症反应，并降低VILI发生风险，提高手术安全性。

Abstract

Objective to analyze the effect of one lung ventilation assisted with low tidal volume high-frequency ventilation mode in thoracoscopic lobectomy.
Methods 96 patients who underwent thoracoscopic lobectomy from February 2020 to February 2021 were randomly divided into experimental group and reference group, with 48 patients in each group. During the operation, the experimental group assisted the low tidal volume high-frequency ventilation mode of the affected lung during one lung ventilation, and the reference group selected the conventional ventilation mode during one lung ventilation, and observed the hemodynamic indexes [arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2)] of the two groups at each time point [two lung ventilation after general anesthesia intubation (T0), one lung ventilation 1H (T1), one lung ventilation 4H (T2)] The levels of inflammatory cytokines [interleukin-10 (IL-10), interleukin-8 (IL-8)] and the incidence of mechanical ventilation related lung injury (VILI).
Results at t0 time point, there was no significant difference in hemodynamic indexes and inflammatory cytokine levels between the two groups (P>0.05); At T1 and T2 time points, the hemodynamic indexes and inflammatory cytokine levels of the two groups increased, in which PaCO2 and PaO2 in the experimental group were higher than those in the reference group, and IL-10 and IL-8 were lower than those in the reference group, with significant differences (P<0.05); The incidence of VILI in the experimental group was significantly lower than that in the reference group (P<0.05).
Conclusion   the effect of one lung ventilation assisted with low tidal volume high-frequency ventilation in the affected side of the lung is satisfactory in thoracoscopic lobectomy, which is conducive to maintaining hemodynamic stability during surgery, reducing inflammatory reaction, reducing the risk of VILI, and improving the safety of surgery.