“过夜通气策略”对高危患者术后肺保护价值的观察  

Overnight ventilation strategy on lung protective value of high risk postoperative patients

作　　者：梁国鹏[1] 王蔚[1] 康焰[1] 刘进[1] 

机构地区：[1]四川大学华西医院重症医学科,四川成都610041

出　　处：《现代预防医学》2013年第4期785-787,共3页Modern Preventive Medicine

摘　　要：目的观察延长术后有创通气时间对高危老年腹部手术患者术后肺部并发症、住院天数和住院期间死亡率的影响。方法连续选择2009年7月1日～2010年12月31日每日20时至d28:00入住外科重症监护病房的老年腹部手术患者,随机分入延长通气组(V组)和常规治疗组(C组),V组术后常规通气治疗至d38:00,C组术后常规通气至全麻苏醒后拔管,观察血气分析、肺部并发症、住院天数、死亡率等。结果共47例患者纳入研究,V组24例,C组23例,V组和C组拔管后24h动脉血气氧分压(PaO2)及氧合指数(PaO2/FiO2)分别为[(100±24)mmHg和(86±19)mmHg)],[(334±80)mmHg和(288±63)mmHg)],差异有统计学意义,两组低氧血症发生率差异无统计学意义(16.7%和39.1%,P﹥0.05);术后48h两组PaO2[(88±12)mmHg和(79±14)mmHg)]、PaO2/FiO2[(295±40)mmHg和(258±45)mmHg]、低氧血症发生率(12.5%和52.2%,P﹤0.05)差异均有统计学意义;V组较C组肺部感染发生率低(4%和26%,P﹤0.05);住院时间和死亡率的差异均无统计学意义。结论对于夜间入住SICU并存在肺部并发症高危风险的老年腹部术后患者,过夜通气能够降低术后低氧血症发生率,减少肺部并发症,但对术后住院时间和住院死亡率无影响。OBJECTIVE To observe pulmonary complication, hospital stay, and mortality on application of postoperative pro- longed invasive mechanical ventilation in elderly patients after abdominal surgery. METHODS The design was a randomized controlled clinical study from July 1% 2009 to December 31%, 2010. Patients were elderly abdominal surgery patients in surgery intensive care unit, and divided into two groups, prolonged ventilation group （V group） and regular treatment group （C group）. V group were given regular mechanical ventilation till 8：00 of the second day, and C group were given regular mechanical ventilation till tracheal extubation after general anesthesia. Arterial blood gas analysis, pulmonary complication, hospi- tal stay and mortality were monitored in both groups. RESULTS 47 eases were included in the study, with 24 in V group and 23 in C group. There was a significant （P 〈 0.05） improvement in PaO2 and PaO2/FiO2 between the two groups. PaO2 and Pa02/ FiOEofV group and C group afterextubation were [（100±24） mm Hgvs （86±19） mm Hg], [（334±80） mm Hgvs （288 ± 63） mm Hg], respectively. There were no significant differences （P 〉 0.05） in hypoxemia, [ 4 （16.7%） vs 9 （39.1%）]. The PaO2, PaOE/FiO2, hypoxemia rate after 48 h were （88 ± 12） mm Hg vs （79 ± 14） mm Hg, （295 ± 40） mm Hg vs （258 ± 45） mm Hg, 12.5% vs 52.2% in V group and C group, respectively. There was a significant （P〈 0.05） improvement in the PaO2, PaO2/FiO2, hypoxemia rate between groups. Pulmonary infection rate lower in V group than in C group [ 1 （4%） vs 6 （26%）], respectively. CONCLUSION Overnight mechanical ventilation strategy may decrease the rate of hypoxemia and respiratory system complication in elderly patients after abdominal surgery with high risk of pulmonary infection. However overnight mechanical ventilation strategy shown no significant differences in hospital stay and mortality.

关 键 词：老年 腹部手术 机械通气 并发症 

分 类 号：R563[医药卫生—呼吸系统]