肺保护性通气策略对腹部术后老年人肺部并发症影响  

INFLUENCE OF LUNG PROTECTIVE VENTILATION STRATEGY ON PULMONARY COMPLICATIONS IN THE AGED AFTER ABDOMINAL SURGERY

作　　者：鲁会卿[1] 高艺凡[1] 于艳宏 周文昱 刘伟[1] 李宏[1] 

机构地区：[1]武警后勤学院附属医院麻醉科,天津300162

出　　处：《齐鲁医学杂志》2016年第6期699-701,共3页Medical Journal of Qilu

摘　　要：目的观察全身麻醉时采用肺保护性通气策略(LPVS)对老年腹部手术病人术后肺部并发症的影响。方法选择ASAⅡ~Ⅲ级、择期行腹部手术病人80例,采用随机数字表法将病人随机分为LPVS组和对照组,每组40例。LPVS组:机械通气模式为间歇正压通气,潮气量(VT)为6~8 mL/kg(理想体质量),呼吸频率(RR)12~18min^(-1),吸呼比(I∶E)为1∶2,呼气末正压(PEEP)1kPa,30 min给予一次肺复张(AR);对照组VT10~12mL/kg,I∶E=1∶2,PEEP为0kPa,不给予AR。观察两组病人于麻醉前(T1)、机械通气1h(T2)、拔管后5min(T3)、拔管后1h(T4)、术后24h(T5)的动脉血气分析情况、氧合指数(PaO_2/FiO_2)、肺泡-动脉血氧分压差(P_(A-a)O_2)及术后肺部并发症(PPCs)的发生情况。结果与对照组相比,LPVS组T2、T3、T4、T5时点PaO_2/FiO_2升高,P_(A-a)O_2降低(t=2.27~6.58,P<0.05);术后7d内,对照组PPCs发生率与LPVS组比较,差异有显著性(χ~2=4.95,P<0.05)。结论 LPVS能有效改善老年腹部手术病人氧合情况,减少肺部并发症的发生。Objective To observe the effect of lung protective ventilation strategy （LPVS） on pulmonary complications in the elderly after abdominal surgery under general anesthesia. Methods Eighty patients-aged 65-80 years, ASA class Ⅱ or Ⅲ-scheduled for elective abdominal surgery were evenly randomized to LPVS group and control group. In the LPVS group： mechanical ventilation mode was intermittent positive pressure ventilation, with tidal volume （TV） of 6-8 mL/kg, RR 12-18 min^-1, I∶E=1∶2, and PEEP=1 kPa. An alveolar recruitment （AR） was given every 30 min. For the control group, TV 10-12 mL/kg, I∶E=1∶2 and PEEP=0 kPa. No AR was given. Arterial blood gas, PaO2/FiO2 and PA-aO2 and pulmonary complications after surgery were observed in the two groups before anesthesia （T1）, 1 h after tracheal intubation （T2）, 5 min after extubation （T3）, 1 h after tracheal extubation （T4）, and 24 h after operation （T5）. Results Compared with the control group, the PaO2/FiO2 in LPVS group at T2,T3,T4 and T5 increased, and PA-aO2 decreased （t=2.27-6.58,P〈0.05）. The difference in incidence of pulmonary complications after surgery between the two groups was significant （χ^2=4.95,P〈0.05）. Conclusion LPVS can effectively improve the oxygenation in elderly patients undergoing abdominal surgery and decrease their pulmonary complications.

关 键 词：肺通气 外科手术 手术后并发症 老年人 

分 类 号：R332[医药卫生—人体生理学] R614.2[医药卫生—基础医学]