肺保护性通气策略对改善高风险患者术后肺部并发症的研究进展  

Effect of lung protective ventilation strategies on improving postoperative pulmonary complications in patients with high risk factors

作　　者：栾芳[1] 栾永[1] 

机构地区：[1]大连医科大学附属第一医院麻醉科,116011

出　　处：《国际麻醉学与复苏杂志》2017年第3期273-277,共5页International Journal of Anesthesiology and Resuscitation

基　　金：大连市科技局科技计划项目（2015E12SF167）

摘　　要：背景肺部并发症是引起术后死亡的最主要原因之一，多种因素可能诱发或加重术后肺部并发症（ postoperativepulmonary complication, PPC ）。预防PPC的方法很多，“肺保护性通气”是其中之一。目的了解“肺保护性通气”策略能否有效改善高风险患者PPC。内容阐述“肺保护性通气”策略能否有效改善合并吸烟、高龄、肺动脉高压、慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）、心脏和神经系统等危险因素患者的PPC。趋向对于患急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）的重症患者，建议使用低潮气量和较高呼气末正压通气（positive end expiratorypressure, PEEP）水平进行机械通气，并且在患者手术期间应该维持该参数设置。对于其他危重患者，低潮气量通气好处的证据也越来越多。尽管如此，也不应该盲目扩大化使用“肺保护性通气”策略，应注意低潮气量通气在保护肺功能的同时可能引起高碳酸血症，而且较高的PEEP可能引起肺过度膨胀、颅内压升高以及对循环产生较大干扰。“肺保护性通气”策略对一些合并症的意义还不清楚，还有待于进一步研究。Background Pulmonary complications are major cause of postoperative mortality. Many factors aggravate pulmonary complications（PPC）. Lung protective ventilation strategy prevents pulmonary complications to some extent. Objective To know if lung protective ventilation strategies can improve clinical outcomes of patients with high risk factors. Content To explain if lung protective ventilation strategies can improve clinical outcomes of patients with high risk factors like smoking, advanced age, pulmonary hypertension, chronic obstructive pulmonary disease （COPD）, cardiac and neurologic diseases, and so on. Trend In patients with acute respiratory distress syndrome （ARDS）, ventilation with low tidal volumes and high level of positive end expiratory pressure（PEEP） are recommended, and intraoperative ventilation should continue the settings applied on the ICU. In other critically ill patients, the evidence for the benefits of low tidal volume ventilation is growing. Low tidal volumes could cause excessive hypercapnia. High level of PEEP could cause dynamic hyperinflation, increased intracranial pressure and increased incidence of hemodynamic instability. We should not use lung protective ventilation strategies blindly. In patients with comorbidities, further research is necessary to find out whether lung protective ventilation should be adopted.

关 键 词：肺保护性通气策 术后肺部并发症 

分 类 号：R614[医药卫生—麻醉学]