小潮气量肺保护通气策略在老年肺功能不全患者行腹腔镜下胃肠手术中的应用研究  

Application of low tidal volume lung protection ventilation strategy in laparoscopic gastrointestinal surgery in elderly patients with pulmonary insufficiency

作　　者：李文静 胡义凤 张雷波 周永连 沈卫红 朱敏敏 郑文泽 Li Wenjing;Hu Yifeng;Zhang Leibo;Zhou Yonglian;Shen Weihong;Zhu Minmin;Zheng Wenze(Department of Anesthesiology,Second People's Hospital of Wuxi City(Second People's Hospital of Wuxi City Affiliated to Nanjing Medical University),Wuxi,Jiangsu,214000,P.R.China;Department of Anesthesiology,Dongfang Hospital Affiliated to Tongji University,Shanghai,201315,P.R.China)

机构地区：[1]无锡市第二人民医院(南京医科大学附属无锡第二医院)麻醉科,江苏无锡214000 [2]同济大学附属东方医院麻醉科,上海201315

出　　处：《老年医学与保健》2020年第4期648-651,共4页Geriatrics & Health Care

摘　　要：目的研究小潮气量肺保护通气在老年肺功能不全患者行腹腔镜胃肠手术中的应用价值。方法纳入2017年5月至-2019年9月于无锡第二医院治疗的老年肺功能不全行腹腔镜下胃肠手术患者80例,采用随机数字表法分为观察组(n=40)和对照组(n=40)。观察组行小潮气量肺保护性通气,对照组行常规大潮气量通气。观察并比较2组患者围术期肺氧合功能指标水平,评估并比较2组白介素-8(IL-8)、白介素-1(IL-1)、肿瘤坏死因子α(TNF-α)和肺泡灌洗液中肺表面活性蛋白D(SP-D)水平,以及术后并发症发生率。结果观察组术后并发症发生率明显低于对照组(P<0.05)。2组患者气管插管时(T1)、插管后5 min(T2)、拔管时(T3)及术后30 min(T4)时动脉血二氧化碳分压(PaCO2)和肺内分流率(Qs/Qt)水平差异均有统计学意义(P<0.01);T2、T3及T4时,观察组氧分压(PaO2)和Qs/Qs均显著高于对照组,PaCO_2显著低于对照组(P<0.01);IL-8、IL-1、TNF-α水平均显著低于对照组,而SP-D水平显著高于对照组(P<0.01)。结论小潮气量肺保护性通气策略用于肺功能不全的老年胃肠手术患者,有助于降低术后并发症,保护肺功能,提高手术安全性,具有一定的应用价值。Objective To study the value of low tidal volume lung protection in laparoscopic gastrointestinal surgery in elderly patients with pulmonary insufficiency. Methods 80 elderly patients with pulmonary insufficiency undergoing laparoscopic gastrointestinal surgery in second people’s hospital of Wuxi city from May 2017 to September 2019 were enrolled and randomly divided into observation group(n=40) and control group(n=40). Observation group received low tidal volume lung protective ventilation, and control group received conventional high tidal volume ventilation. The perioperative lung oxygenation function indexes of the two groups were observed and compared;the levels of interleukin-8(IL-8), interleukin-1(IL-1), tumor necrosis factor-α(TNF-α) and pulmonary surfactant protein D(SP-D) in alveolar lavage fluid(BALF), as well as the incidence of postoperative complications were evaluated and compared between the two groups. Results The incidence of postoperative complications in the observation group was significantly lower than that in the control group(P <0.05). There were statistically significant differences in carbon dioxide pressure(PaCO2) and intrapulmonary shunt rate(Qs/Qt) levels at the time of tracheal intubation(T1), 5 min after intubation(T2), extubation(T3) and 30 min after operation(T4) between the two groups(P<0.01). At T2, T3 and T4, the partial pressure of oxygen(PaO2) and QS/QS of the observation group were significantly higher than those of the control group, PaCO2 was significantly lower than that of the control group(P<0.01), the levels of IL-8, IL-1, TNF-α were significantly lower than those of the control group, while the level of SP-D was significantly higher than that of the control group(P<0.01). Conclusion The low tidal volume lung protective ventilation strategy for elderly patients with pulmonary insufficiency undergoing gastrointestinal surgery can help to reduce postoperative complications, protect lung function, and improve the safety of surgery.

关 键 词：老年 肺功能不全 腹腔镜胃肠手术 小潮气量 肺保护性通气 

分 类 号：R656[医药卫生—外科学]