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Abstract：
OBJECTIVE: To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas.
METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, n=33) and inverse ventilation group (group R, n=33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T1), OLV30 min (T2), OLV60 min (T3), and 15 min after recovery of TLV (T4). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE).
RESULTS: Sixty-three infants were finally included in this study. At T2 and T3, Cdyn, PaO2 and OI in group R were significantly higher (P < 0.05) and Ppeak, PaCO2 and PA-aO2 were significantly lower than those in group N (P < 0.05). There was no significant difference in HR or MAP between the two groups at T2 and T3 (P > 0.05). The level of RAGE significantly increased after the surgery in both groups (P < 0.05), and was significantly lower in R group than in N group (P < 0.05).
CONCLUSIONS: In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, n=33) and inverse ventilation group (group R, n=33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T1), OLV30 min (T2), OLV60 min (T3), and 15 min after recovery of TLV (T4). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE).
RESULTS: Sixty-three infants were finally included in this study. At T2 and T3, Cdyn, PaO2 and OI in group R were significantly higher (P < 0.05) and Ppeak, PaCO2 and PA-aO2 were significantly lower than those in group N (P < 0.05). There was no significant difference in HR or MAP between the two groups at T2 and T3 (P > 0.05). The level of RAGE significantly increased after the surgery in both groups (P < 0.05), and was significantly lower in R group than in N group (P < 0.05).
CONCLUSIONS: In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
摘要：
目的：探讨逆比通气(IRV)联合呼气末正压(PEEP)在婴幼儿胸腔镜单肺通气(OLV)治疗肺囊腺瘤中的应用效果。
方法：从2月起，我院共66名婴儿接受了OLV胸腔镜手术治疗肺囊腺瘤，2018年2月,2019年随机分为常规通气组(N组，n=33）和逆通气组（R组，n=33）。记录婴儿的血流动力学和呼吸参数，并在两肺通气（TLV）后15分钟（T1）进行动脉血气分析。OLV30分钟（T2），OLV60分钟(T3),和15分钟后恢复TLV（T4）。收集手术前后的支气管肺泡灌洗液，检测晚期糖基化终产物受体（RAGE）的表达水平。
结果：63名婴儿最终被纳入本研究。在T2和T3，Cdyn，R组PaO2和OI明显高于P<0.05,PaCO2和PA-aO2明显低于N组(P<0.05)。两组在T2和T3时的HR或MAP差异无统计学意义（P>0.05）。两组患者术后RAGE水平均显著升高(P<0.05),R组明显低于N组(P<0.05)。
结论：在接受OLV胸腔镜手术治疗肺囊腺瘤的婴儿中，适当的IRV联合PEEP不影响血流动力学稳定性，可增加肺顺应性，降低峰值压力，改善氧合以提供肺保护。
方法：从2月起，我院共66名婴儿接受了OLV胸腔镜手术治疗肺囊腺瘤，2018年2月,2019年随机分为常规通气组(N组，n=33）和逆通气组（R组，n=33）。记录婴儿的血流动力学和呼吸参数，并在两肺通气（TLV）后15分钟（T1）进行动脉血气分析。OLV30分钟（T2），OLV60分钟(T3),和15分钟后恢复TLV（T4）。收集手术前后的支气管肺泡灌洗液，检测晚期糖基化终产物受体（RAGE）的表达水平。
结果：63名婴儿最终被纳入本研究。在T2和T3，Cdyn，R组PaO2和OI明显高于P<0.05,PaCO2和PA-aO2明显低于N组(P<0.05)。两组在T2和T3时的HR或MAP差异无统计学意义（P>0.05）。两组患者术后RAGE水平均显著升高(P<0.05),R组明显低于N组(P<0.05)。
结论：在接受OLV胸腔镜手术治疗肺囊腺瘤的婴儿中，适当的IRV联合PEEP不影响血流动力学稳定性，可增加肺顺应性，降低峰值压力，改善氧合以提供肺保护。
