关键词: 大容量全肺灌洗, 肺保护性通气, 尘肺, 肺损伤, 肺功能, 肺顺应性

Abstract:

Objective To investigate the effect of protective lung ventilation in the application of whole-lung lavage in patients with pneumoconiosis，and provide reference for reducing intraoperative lung injury. Methods A total of 121 patients who underwent elective large-volume whole-lung lavage in Beidaihe Rehabilitation Institution of Ministry of Emergency Management from March to July 2023 were selected as the research subjects and randomly divided into two groups. The control group consisted of 60 patients who received conventional mechanical ventilation，while the study group consisted of 61 patients who received protective mechanical ventilation. The mechanics indexes such as peak airway pressure，dynamic lung compliance，expiratory resistance，and respiratory work were measured and recorded for each time point before and after single-lung lavage，after double-lung lavage，and before extubation in both groups. Hemodynamic indexes such as mean arterial pressure and heart rate were monitored，and arterial blood gas analysis was performed to obtain oxygen partial pressure and carbon dioxide partial pressure. By comparing and analyzing the changes in these physiological parameters，the pathological and physiological status of patients at different time points could be comprehensively evaluated. These data helped doctors adjust treatment plans in a timely manner to improve patients' rehabilitation outcomes. The pulmonary function indexes，such as maximum ventilation volume（MVV），forced vital capacity（FVC），forced expiratory volume in one second（FEV_1.0） and flow during forced expiration of 75% to 25%（FEF_75/25） were measured before and on the second day after surgery，and the occurrence of postoperative complications was observed. Results At the three time points after single-lung lavage，after double-lung lavage，and before extubation，the PO₂ and dynamic lung compliance indexes in the observation group were （381.62±41.68），（384.20±30.78），（393.98±41.54）mmHg and （34.82±2.82），（34.49±3.77），（38.54±3.29）mL/cmH₂O，respectively，which were significantly higher than those in the control group[（363.58±48.79），（364.07±37.50），（367.65±35.23）mmHg，（32.80±4.22），（29.32±2.95），（32.85±4.07）mL/cmH₂O]，while the indexes of peak airway pressure，respiratory work，and expiratory resistance in the observation group were （23.88±3.07），（31.80±3.40），（26.28±3.06）cmH₂O，（1.47±0.28），（1.76±0.38），（1.50±0.27）J，（19.69±3.36），（22.64±2.70），（19.03±2.79）cmH₂O（L·S），respectively，which were significantly lower than those in the control group[（26.37±2.93），（33.05±2.97），（29.67±3.92）cmH₂O，（1.63±0.44），（2.01±0.73），（1.97±0.35）J，（23.52±3.14），（25.57±2.84），（22.42±3.41）cmH₂O（L·S）]，with statistically significant differences（all P<0.05）. There were no statistically significant differences in hemodynamic indexes between the two groups（all P>0.05）. On the second day after surgery，the pulmonary function indexes of the study group and the control group，including MVV，FVC，FEV_1.0，and FEF_75/25 showed significant improvement compared to preoperative levels，with statistically significant differences（all P<0.05）. Conclusion The protective lung ventilation strategy can reduce peak airway pressure and respiratory work，alleviate lung injury，improve oxygenation，and reduce postoperative complications，which is safe and effective in the application of whole-lung lavage.

Key words: Whole-lung lavage, Protective lung ventilation, Pneumoconiosis, Lung injury, Pulmonary function, Lung compliance