小潮气量联合低水平呼吸末正压通气用于老年患者腹腔镜手术的术中和术后情况评估  

Intraoperative and postoperative evaluation of low tidal volume combined with low-level positive end-expiratory pressure ventilation in laparoscopic surgery in elderly patients

作　　者：李冶秋 赵正兰 李琴芳 

机构地区：[1]湖北省武汉市东西湖区人民医院麻醉科,湖北武汉430040

出　　处：《海南医学院学报》2016年第1期51-54,58,共5页Journal of Hainan Medical University

基　　金：武汉市卫生局临床医学科研项目(WZ09D11)~~

摘　　要：目的:评估小潮气量联合低水平呼吸末正压通气用于老年患者腹腔镜手术的术中和术后情况。方法:选取在本院接受腹腔镜手术治疗的老年患者(年龄>60岁)176例作为研究对象,随机分为观察组及对照组各88例,对照组接受常规通气策略,观察组接受小潮气量联合低水平呼吸末正压通气策略,对比两组血流动力学、呼吸力学、血清学、脑血管相关指标等水平差异。结果:观察组术中及术后的心率、平均动脉压水平低于对照组,动脉血氧分压、氧合指数水平高于对照组,差异有统计学意义(P<0.05);观察组术中APIP、Pplat值低于对照组,Cs值高于对照组,差异有统计学意义(P<0.05);观察组患者的术中及术后的血清IL-8、TNF-α水平均低于对照组患者,IL-10水平高于对照组患者,差异具有统计学意义(P<0.05);观察组患者的术中及术后观察组患者的PjvO_2、SjvO_2、CjvO_2水平高于对照组患者,Da-jvO_2水平低于对照组患者,差异有统计学意义(P<0.05)。结论:老年患者接受腹腔镜手术时,采用小潮气量联合低水平呼吸末正压通气策略,可以稳定血流动力学水平及呼吸功能,降低全身炎症状态及对患者的脑血供影响。Objective： To evaluate intraoperative and postoperative condition of low tidal volume combined with low-lev- el positive end-expiratory pressure ventilation in laparoscopic surgery in elderly patients. Methods： A total of 176 elderly pa- tients （more than 60 years old） receiving laparoscopic surgery in our hospital were selected as research subiects and randomly divided into observation group and control group, each group included 88 cases, control group received conventional ventilation strategy, observation group received low tidal volume combined with low-level positive end-expiratory pressure ventilation strategy, and then levels of hemodynamic indexes, respiratory mechanical indexes, serology indexes and cerebral vessel related indexes, etc of two groups were compared. Results： Intraoperative and postoperative heart rate and mean arterial pressure lev- els of observation group were lower than those of control group, arterial partial pressure of oxygen and oxygenation index levels were higher than those of control group and differences had statistical significance （P^0.05）~ intraoperative APIP and Pplat values of observation group were lower than those of control group, Cs value was higher than that of control group and differ- ences had statistical significance （P〈0. 05）; intraoperative and postoperative serum IL-8 and TNFa levels of observation group were lower than those of control group, IL-10 level was higher than that of control group and differences had statistical significance （P〈0.05） ; intraoperative and postoperative PjvO2 , SjvO2 and CjvO2 levels of observation group were higher than those of control group, Da-jvO2 level was lower than that of control group and differences had statistical significance （P〈 0.05）. Oonclusion： When elderly patients receive laparoscopic surgery, the use of low tidal volume combined with low-level positive end-expiratory pressure ventilation strategy can stabilize hemodynamic level and respiratory function as well as reduce systemic in

关 键 词：老年 腹腔镜 小潮气量 低水平呼吸末正压通气 

分 类 号：R656[医药卫生—外科学]