肺保护性通气可减轻轻中度慢性阻塞性肺疾病老年患者围术期肺部感染  

Effect of lung protective ventilation on perioperative pulmonary infection in patients with mild to moderate chronic obstructive pulmonary disease

作　　者：谭义文[1] 田毅[1] 魏晓[1] 程亮亮[1] 符白嫩[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院海口市人民医院麻醉科,570208

出　　处：《临床麻醉学杂志》2017年第7期660-663,共4页Journal of Clinical Anesthesiology

基　　金：中南大学湘雅医学院附属海口医院科研项目(2016-YNJ-010-010)

摘　　要：目的探讨肺保护性通气对全麻轻中度慢性阻塞性肺疾病(COPD)老年患者围术期肺部感染的影响。方法选择择期行全麻上腹部手术的轻中度COPD老年患者40例,男24例,女16例,年龄65~81岁,ASAⅠ~Ⅲ级,BMI 19~28kg/m^2,采用随机数字表分为肺保护性通气组(PV组)和常规通气组(CV组),每组20例。PV组行肺保护通气:IPPV,V_T 6ml/kg,PEEP 5~10cm H_2O,每隔30分钟进行手法肺复张;CV组行常规通气:IPPV,V_T 10 ml/kg,不使用PEEP及肺复张。于麻醉诱导前(T_1)、机械通气后2h(T_2)、术毕时(T_3)、术后6hT_4)和24h(T_5)采集静脉血检测IL-6和IL-8的浓度;记录麻醉前、术后第1、3、5、7天的临床肺部感染评分(CPIS)和术后肺部炎症发生情况。结果两组患者年龄、BMI、ASA分级、术中输液量、出血量、尿量、机械通气时间、手术方式、T_1~T_5时IL-6和IL-8浓度组间差异均无统计学意义。与T_1时比较,T_2~T_5时两组IL-6和IL-8浓度明显升高(P<0.05)。与麻醉前比较,术后第1、3、5天CV组CPIS评分和术后肺部炎症发生率明显升高(P<0.05);术后第1、3、5天PV组CPIS评分明显低于CV组(P<0.05)。结论肺保护性通气不能降低开腹手术轻中度COPD老年患者围术期IL-6和IL-8浓度,但是可减少术后肺部炎症的发生,减轻术后5d内的肺部感染。Objective To investigate the effect of perioperative pulmonary infection in elderly patients with mild to moderate chronic obstructive pulmonary disease（COPD）undergoing general anesthesia.Methods Forty elderly patients undergoing general anesthesia and abdominal surgery,24 males,16females,aged 65-81 years,ASA physical statusⅠ-Ⅲ,BMI 19-28kg/m^2,were randomly divided into two groups（n=20 each）：protective ventilation group（group PV）and conventional ventilation group（group CV）.Lung protective ventilation was received in group PV：intermittent positive pressure ventilation,tidal volume 6ml/kg（ideal body weight）,positive end expiratory pressure（PEEP）5-10 cm H2O,alveolar recruitment maneuver every 30minutes;conventional ventilation was received in group CV：intermittent positive pressure ventilation,tidal volume 10 ml/kg（ideal body weight）,without using the PEEP and alveolar recruitment maneuver.Venous blood samples for interleukin 6（IL-6）and interleukin-8（IL-8）were taken at five different time points：before the anesthesia induction（T1）,2hafter mechanical ventilation（T2）,at the end of operation（T3）,6h（T4）and 24h（T5）after operation.The clinical pulmonary infection score（CPIS）was recorded at before anesthesia,days 1,3,5and 7after surgery.The incidence of postoperative pulmonary inflammation was also recorded.Results There was no statistical difference in the two groups with respect to age,body mass index,ASA physical status,intraoperative volume of infusion,estimated blood loss,urine volume,mechanical ventilation time,operation method and IL-6,IL-8levels at T1-T5.Compared with T1,the IL-6and IL-8levels in two groups at T2-T5 increased significantly（P〈0.05）.Compared that before anesthesia,CPIS in group CV on postoperative days 1,3and 5increased significantly（P〈0.05）;compared with group CV,CPIS and the incidence of postoperative pulmonary inflammation in group PV reduced significantly on postoperative days 1,3 and 5（P〈0.05）.Conclusion Lu

关 键 词：正压通气 慢性阻塞性肺疾病 肺部感染 

分 类 号：R563.9[医药卫生—呼吸系统] R614.2[医药卫生—内科学]