文章摘要
长时间保护性单肺通气与新生儿术后康复指标的相关性
Association between prolonged protective one-lung ventilation strategy with postoperative rehabilitation in neonates
  
DOI：10.12089/jca.2021.04.009
中文关键词: 保护性单肺通气策略  双肺通气  新生儿  先天性食管闭锁  食管重建术
英文关键词: Protective one-lung ventilation strategy  Double lung ventilation  Neonates  Congenital esophageal atresia  Esophageal reconstruction
基金项目:安徽省自然科学基金面上项目(1808085MH230)；安徽省科技创新战略与软科学研究专项(201806a02020045)
作者单位E-mail
孙盈盈 230051,合肥市,安徽医科大学附属省儿童医院(安徽省儿童医院)麻醉科 sunyy168@126.com 
刘俊霞 230051,合肥市,安徽医科大学附属省儿童医院(安徽省儿童医院)麻醉科  
夏迎静 230051,合肥市,安徽医科大学附属省儿童医院(安徽省儿童医院)麻醉科  
纪学武 230051,合肥市,安徽医科大学附属省儿童医院(安徽省儿童医院)麻醉科  
汪俊 230051,合肥市,安徽医科大学附属省儿童医院(安徽省儿童医院)麻醉科  
叶宏武 230051,合肥市,安徽医科大学附属省儿童医院(安徽省儿童医院)麻醉科  
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中文摘要:
      
目的 分析和比较长时间(＞2 h)保护性单肺通气策略(P-OLV)与压力控制双肺通气模式(PC-DLV)对新生儿术后康复的影响。
方法 回顾性分析2017年1月至2020年10月因先天性食管闭锁(CEA)行食管重建术的新生儿60例，男34例，女26例，日龄<28 d，CEA Ⅲa或Ⅲb型。按术中通气管理模式分为两组：P-OLV组(n＝28)和PC-DLV组(n＝32)。P-OLV组外科操作过程中采用P-OLV，麻醉诱导后和外科手术结束采用PC-DLV；PC-DLV组麻醉诱导后至手术结束全程采用PC-DLV。收集并整理手术时间和麻醉时间，以及患儿术中双肺通气15 min(T0)、手术开始30 min(T1)、手术开始120 min(T2)、手术结束即刻(T3)的PaO2、PaCO2、吸气峰压(PIP)、肺动态顺应性(Cdyn)。收集并整理患儿术后康复指标：术后肺损伤情况，术后呼吸机撤机时间、初次进食时间、术后住院时间、并发症等。采用Logistic回归分析术中通气模式与术后康复指标的相关性。
结果 与PC-DLV组比较，P-OLV组手术时间和麻醉时间明显缩短(P＜0.05)，T1和T2时PaO2明显升高(P＜0.05)、PaCO2明显降低(P＜0.05)。T0—T3时两组PIP、Cdyn差异无统计学意义。两组术后撤机时间、初次进食时间及术后住院时间差异无统计学意义。Logistic回归分析显示，术中通气模式与术后CRP浓度、术后撤机时间、初次进食时间、术后住院时间及术后并发症等无明显相关性。
结论 在新生儿食管重建术中，长时间(>2 h)P-OLV与PC-DLV通气模式对术后康复指标的影响无明显差异。
英文摘要:
      
Objective To compare the effects of prolonged protective one-lung ventilation (P-OLV) with pressure control double-lung ventilation (PC-DLV) on postoperative rehabilitation in neonates.
Methods Electronic medical records of Anhui Provincial Children's Hospital from January 2017 to October 2020 were reviewed. Sixty newborns undergoing esophageal reconstruction due to congenital esophageal atresia (CEA), 34 males and 26 females, aged < 28 days, CEA Ⅲa or Ⅲb were included. According to intraoperative ventilation mode, the newborns were divided into two groups: P-OLV group (n = 28) and PC-DLV group (n = 32). P-OLV was used only during surgical procedures in P-OLV group, PC-DLV was used in the other stages in P-OLV group and the whole procedures in PC-DLV group. PIP, Dynamic Compliance (Cdyn), PaO2 and PaCO2 were reviewed and compared between the two groups at the following time points, 15 minutes after double-lung ventilation (T0), 30 minutes after operation (T1), 120 minutes after operation (T2) and at the end of the operation (T3). Index of postoperative rehabilitation were evaluated such as the time for postoperative ventilator withdrawal, first feeding and postoperative hospitalization and complications. Logistic regression analysis was performed between intraoperative ventilation mode and postoperative CRP value, time of postoperative withdrawal, first feeding and postoperative hospital stay, and postoperative complications.
Results Compared with PC-DLV group, operation time and anesthesia time were significantly shortened in P-OLV group (P < 0.05), PaO2 were higher and PaCO2 were lower at T1 and T2 in P-OLV group (P < 0.05). Compared with T0, PIP increased while Cdyn decreased significantly at T1 and T2 in both groups (P < 0.05), but there was no significant difference between the two groups. There were no significant differences in the time of postoperative ventilator withdrawal, first feeding and postoperative hospitalization between the two groups. Logistic regression showed no significant correlation between intraoperative ventilation mode and postoperative CRP value, time of postoperative withdrawal, first feeding and postoperative hospital stay, and postoperative complications.
Conclusion In neonatal esophageal reconstruction, there was no significantly difference in the effect of prolonged P-OLV and PC-DLV ventilation mode on postoperative rehabilitation indicators.
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