不同通气模式对老年患者腹腔镜手术肺保护及肺功能优化的影响  

Effect of Different Ventilation Modes on Lung Protection and Pulmonary Function Optimization in Elderly Patients under Laparoscopic Surgery

作　　者：丁韶丽 高彦军 阎文军[1] 黄锦文[1] 刘若彬[1] 赫曼[1] 王冬[1] 丁培炎[1] 邓菲 冯晓雪 

机构地区：[1]甘肃省人民医院麻醉科,甘肃省兰州市730000

出　　处：《医学理论与实践》2018年第4期472-474,共3页The Journal of Medical Theory and Practice

基　　金：兰州市科技发展计划项目(2015-ZD-19)

摘　　要：目的:分析不同通气模式对老年患者腹腔镜手术肺保护及肺功能优化的影响。方法:回顾性分析96例老年腹腔镜手术患者的临床资料,根据不同通气模式进行分组;对照组(VCV常规组)占46.88%(45/96),采取传统通气策略进行容量控制(VCV)通气模式;观察组(PC-VG肺保护组)占53.13%(51/96),采取压力控制容量保证(PC-VG)通气模式下肺保护性通气策略;对比两组麻醉诱导前(T1)、手术开始后2h(T3)及术毕拔管后10min(T4)的血气分析结果,对比两组气腹前(T2)及T3的呼吸力学指标及氧合指标。结果:与T1时对比,两组患者T3、T4时pH值均显著减小,PaCO_2值均显著增大(P<0.05);观察组T3、T4时的PaCO_2值均显著小于对照组(P<0.05),组间pH、PaO_2差异无统计学意义(P>0.05);观察组T2、T3时的PETCO_2、Ppeak值均显著小于对照组,差异有统计学意义(P<0.05);组间Pmean值差异无统计学意义(P>0.05);观察组T3时的A-aDO_2、RI值均显著小于对照组,PaO_2/FiO_2、Cdyn均显著大于对照组,差异有统计学意义(P<0.05),两组T2的氧合指标及T3时的VD/VT差异无统计学意义(P>0.05)。结论:采取压力控制容量保证(PC-VG)通气模式下肺保护性通气策略较传统通气策略进行容量控制(VCV)通气模式更有利于提高老年腹腔镜手术患者的肺通气效率,减小气腹对肺功能的影响,在呼吸管理中起到保护及优化肺功能的关键作用。Objective:To analyze the effects of different ventilation modes on lung protection and pulmonary function optimization in elderly patients undergoing laparoscopic surgery.Methods:The clinical data of 96 elderly patients undergoing laparoscopic surgery were retrospectively analyzed.The patients were divided into different ventilation modes.The control group(VCV group)accounted for 46.88%(45/96),and the conventional ventilation strategy was used for volume control(VCV)ventilation(PC-VG group),and 53.12%(51/96)in the observation group(PC-VG lung protection group).The protective ventilation strategy under PC-VG ventilation was compared.The results of blood gas analysis at 2 h(T3)and 10 min(T4)after operation were compared between the two groups before pneumoperitoneum(T2)and T3 respiratory mechanics and oxygenation index.Results:Compared with T1,the pH values of both groups were significantly decreased at T3 and T4,PaCO_2 values were significantly increased(P<0.05),while PaCO_2 in T3 and T4 in observation group were significantly lower than those in control group(P<0.05).The PETCO_2 and P_(peak)values at T2 and T3 in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the Pmeanvalues between the two groups(P>0.05).The A-aDO_2 and RI values of T3 in observation group were significantly lower than those in control group,PaO_2/FiO_2 and Cdyn were significantly higher than those in control group(P<0.05).The oxygenation index of T2 and VD/VT The difference was not significant(P>0.05).Conclusion:Ventilatory ventilatory strategy with pressure-controlled volume(PC-VG)ventilation is superior to traditional ventilation strategy in volume control(VCV)ventilation in favor of improving pulmonary ventilation efficiency and reducing pneumoperitoneum in elderly patients undergoing laparoscopic surgery The impact on lung function plays a key role in respiratory protection by optimizing and protecting lung function.

关 键 词：老年腹腔镜手术 传统通气策略 肺保护性通气策略 肺功能 

分 类 号：R65[医药卫生—外科学]