肝移植术中肺保护性通气策略对术后肺部感染及肺功能、氧化应激的影响研究  

Influence of lung protective ventilation strategy during liver transplantation on postoperative pulmonary infection,lung function,and oxidative stress

作　　者：徐广[1] 郭海明[1] 卜慧莲[1] 郭文治[2] 韩雪萍[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,河南郑州450052 [2]郑州大学第一附属医院肝胆外科,河南郑州450052

出　　处：《中华医院感染学杂志》2016年第22期5159-5162,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81500964)

摘　　要：目的探讨肝移植术中肺保护性通气策略(LPVS)对术后肺部感染及肺功能、氧化应激的影响,为肝移植术中通气方式的选择提供参考。方法选取2013年1月-2015年10月在医院住院行肝移植手术的患者80例,随机分为LPVS组与对照组,每组各40例,LPVS组术中给与LPVS模式下机械通气,对照组术中常规机械通气,观察两组患者术后肺部感染,术前、术后3d时用力通气量(FVC)、第一秒用力呼气量(FEV1)、每分钟最大通气量(MVV)、动脉氧分压(PaO2)、超氧化物歧化酶(SOD)、丙二醛(MDA)浓度。结果术后33例患者发生肺部感染,感染率为41.25%,LPVS组患者感染率30.00%低于对照组52.50%(P<0.05);肺部感染患者痰细菌培养阳性21例,阳性率为63.64%,培养出病原菌24株,其中革兰阴性菌15株、革兰阳性菌9株,分别占62.50%、37.50%,感染病原菌主要为肺炎克雷伯菌8株、肺炎链球菌5株、铜绿假单胞菌4株、金黄色葡萄球菌3株,分别占33.33%、20.83%、16.67%、12.50%;两组术后FVC、FEV1、MVV、PaO2、SOD均较术前下降,MDA较术前升高,术后FVC、FEV1、MVV、PaO2、SOD水平LPVS组高于对照组,MDA低于对照组,比较差异有统计学意义(P<0.05)。结论肝移植术中LPVS能降低术后肺部感染发生率,保护肺功能、减轻氧化应激反应。OBJECTIVE To explore the effect of lung protective ventilation strategy （LPVS） during liver transplan‐tation on postoperative pulmonary infection ,lung function ,and oxidative stress so as to choose appropriate venti‐lation approach during the liver transplantation .METHODS A total of 80 patients who were hospitalized and under‐went the liver transplantation from Jan 2013 to Oct 2015 were enrolled in the study and randomly divided into the LPVS group and the control group ,with 40 cases in each .The LPVS group was given intraoperative mechanical ventilation under LPVS mode ,while the control group was treated with intraoperative conventional mechanical ventilation .The incidence of postoperative pulmonary infection and the forced vital capacity （FVC） ,forced expira‐tory volume in 1 second （FEV1） ,maximum voluntary ventilation （MVV） ,partial pressure of arterial oxygen （PaO2 ） ,superoxide dismutase （SOD） ,and malondialdehyde （MDA） concentration before the surgery and after the surgery for 3 days were observed and compared between the two groups of patients .RESULTS Totally 33 pa‐tients had postoperative pulmonary infection ,with the infection rate 41 .25% ;the infection rate of the LPVS group was 30 .00% ,lower than 52 .50% of the control group （P〈0 .05） .The sputum culture was positive in 21 patients with pulmonary infection ,with the positive rate 63 .64% .A total of 24 strains of pathogens were isola‐ted ,including 15 （62 .50% ） strains of gram‐negative bacteria and 9 （37 .50% ） strains of gram‐positive bacteria . The Klebsiella pneumoniae （8 strains） , Streptococcus pneumoniae （5 strains） , Pseudomonas aeruginosa （4 strains） ,and Staphylococcus aureus （3 strains） were the major species of pathogens causing the infection ,accounting for 33 .33% ,20 .83% ,16 .67% ,and 12 .50% ,respectively .The FVC ,FEV1 ,MVV ,PaO2 ,and SOD of the two groups of patients declined after the surgery ,while the MDA was elevated after the surgery .The levels of

关 键 词：肝移植 肺保护性通气策略 术后 肺部感染 肺功能 氧化应激 

分 类 号：R657.3[医药卫生—外科学]