小潮气量肺保护性通气对老年合并肺功能不全胃肠手术患者术后转归的影响  

Effect of low tidal volume lung protective ventilation strategy on the outcome of elderly patients with poor pulmonary function after abdominal operation

作　　者：彭晓慧[1] 顾尔伟[1] 郑立山[1] 张雷[1] 陈菁菁[1] 毛煜[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥市230032

出　　处：《临床麻醉学杂志》2017年第4期364-368,共5页Journal of Clinical Anesthesiology

基　　金：安徽省科技攻关计划项目(1301042204)

摘　　要：目的观察小潮气量(VT)肺保护性通气对老年合并肺功能不全胃肠手术患者术后转`归的影响。方法择期行开放胃肠手术合并肺功能不全患者80例,男64例,女16例,年龄≥65岁,ASAⅡ或Ⅲ级,NYHA心功能Ⅱ或Ⅲ级,预计手术时间2~4h。采用随机数字表法将患者分为两组:保护性通气管理组(P组)和传统机械通气组(C组),每组40例。两组均采用多模式麻醉管理策略。麻醉诱导气管插管后按研究分组设置呼吸参数,调节RR,维持PETCO2在35~45mm Hg。术前第1天、术后第1、3天行动脉血气分析;记录患者自主呼吸恢复时间、清醒时间、拔管时间、PACU驻留时间、排气时间、下床活动时间、术后出院时间以及住院费用;记录术后30d内主要并发症的发生情况。结果 C组术后第1、3天PaO2明显低于术前(P<0.05),术后第1、3天PaCO2明显高于P组(P<0.05)。P组PACU驻留时间为(76.63±29.72)min,明显短于C组的(93.80±42.90)min(P<0.05);两组自主呼吸恢复时间、清醒时间、拔管时间、排气时间、下床活动时间、术后住院时间以及住院费用差异无统计学意义。术后30d内,P组患者发生呼吸衰竭2例(5.0%),肺炎3例(7.5%);C组患者发生呼吸衰竭5例(12.5%)、肺炎3例(7.5%)、术后出血1例(2.5%)和谵妄1例(2.5%),两组术后30d内主要并发症发生率差异无统计学意义。结论在本研究条件下,小VT肺保护性通气能改善老年合并肺功能不全胃肠手术患者的术后氧合,有助于减少术后不良反应的发生。Objective To observe the effect of low tidal volume lung protective ventilation management strategy on postoperative outcome of elderly patients with poor pulmonary function after abdominal surgery.Methods Eighty patients of poor pulmonary function undergoing open gastrointestinal surgery,male 64 cases,female 16 cases,aged over 65 years old,ASA physical statusⅡ orⅢ,NYHA cardiac function Ⅱ or Ⅲ grade,expected operation time 2-4 h were screened.The patients were randomly divided into 2groups：protective ventilation management group（group P）and conventional mechanical ventilation group（group C）,40 cases in each group.Multi-mode anesthetic management was performed in both groups.The respiratory parameters were adjusted according to the group after tracheal intubation,and the respiratory rate was adjusted to maintain PETCO235-45 mm Hg.The blood gas evaluated postoperative oxygen and postoperative spontaneous breathing recovery time,recovery time,extubation time,PACU time,gastrointestinal function recovery time,ambulation time,hospital stay and cost of hospitalization were recorded.The occurrence of major complications were observed at 30 days after surgery.Results PaO_2 of group C was significantly decreased at 1and 3days after surgery than that before operation（P〈0.05）,PaCO_2 of group C was significantly higher at 1and 3days after surgery than that of group P（P〈0.05）;PACU residence time of group P was（76.63±29.72）min,significantly shorter than that of group C[（93.80±42.90）min]（P〈0.05）;The difference spontaneous breathing recovery time,awake time,extubation time,exhaust time,ambulation time,postoperative hospitalization time and hospitalization expenses of two group was not statistically significant.Within 30 dafter operation,2cases（5%）of respiratory failure patients,3cases（7.5%）of pneumonia in group P;5cases（12.5%）of respiratory failure patients,3cases（7.5%）of pneumonia,postoperative hemorrhage in 1cases（2.5%）and 1cases（2.5%）delirium in group C,ther

关 键 词：肺保护性通气管理策略 老年 肺功能不全 肺炎 呼吸衰竭 

分 类 号：R614[医药卫生—麻醉学]