肺保护性通气策略对高原地区肝包虫根治术患者术后氧合功能的影响  

Effect of lung protective ventilation strategy on the function of lung oxgenation in patients undergoing radical surgical procedures for hepatic echinococcosis at high altitude

作　　者：姜徽[1] 汪欢[1] 黄丹 王纯辉[1] 顾尔伟[1] JIANG Hui;WANG Huan;HUANG Dan;WANG Chunhui;GU Erwei(Department of Anesthesiology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Department of Anesthesiology,Shannan People s Hospital,Shannan 856300,China)

机构地区：[1]安徽医科大学第一附属医院麻醉科,安徽合肥230022 [2]西藏自治区山南市人民医院麻醉科,西藏山南856300

出　　处：《麻醉安全与质控》2020年第6期341-344,共4页Perioperative Safety and Quality Assurance

基　　金：安徽省重点研究与开发计划项目(1704a0802165)。

摘　　要：目的观察肺保护性通气策略(LPVS)对高原低氧环境下肝包虫病患者全身麻醉术后氧合功能及术后肺部并发症(PPC)的影响。方法在西藏山南地区(海拔3600 m)选择60例择期在全身麻醉下行肝包虫根治术的患者,按随机数字表法分为标准通气组(C组,n=30)[潮气量(V_T)=10 mL/kg,呼吸频率(RR)10次/min,吸气呼气时间比值(I∶E)=1∶2,呼气末正压(PEEP)=0 cmH_2O]以及肺保护性通气组(L组,n=30)(V_T=6 mL/kg, RR 12~16次/min, I∶E=1∶2, PEEP=5 cmH_2O)。L组每30 min进行一次肺复张。记录患者术前(T_0)、诱导后1 h(T_1)、拔管后(T_2)和术后1 d (T_3)抽取动脉血行动脉血气分析,并且记录患者术后3 d(T_4)的脉搏血氧饱和度(SpO_2)。比较2组患者各时间点的SpO_2、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、氧合指数及术后3 d内、 7 d内PPC的发生情况。结果两组患者在T_2、 T_3、 T_4的SpO_2, T_1、 T_2、 T_3的PaO_2及氧合指数有统计学意义(P<0.05), L组的指标均高于C组。L组术后3 d内、 7 d内相关PPC的发生率明显低于C组(P<0.05)。结论 LPVS可以改善高原低氧环境下全身麻醉患者术后呼吸功能,提高氧合指标,降低相关PPC发生率。Objective To explore the effect of lung protective ventilation strategy(LPVS)on postoperative oxygenation function and postoperative pulmonary complications(PPC)in patients with hepatic echinococcosis under high altitude hypoxic environment.Methods Altogether 60 patients undergoing radical surgical procedures for downlink liver hydatid in Tibet shannan area(elevation 3600 meters)were selected and were randomly divided into standard ventilation group(group C,n=30)[tidal volume(V T)=10 mL/kg,respiration rate(RR)10 times/min,inspiratory-to-expiratory ratio(I∶[KG-2mm]E)=1∶[KG-2mm]2,positive end expiration pressure(PEEP)=0 cmH 2O]and protective ventilation group(group L,n=30)[V T=6 mL/kg,RR 12-16 times/min,inspiratory-to-expiratory ratio(I∶[KG-2mm]E)=1∶[KG-2mm]2,PEEP=5 cmH 2O].Group L underwent pulmonary retentions every 30 minutes.Arterial blood was extracted for arterial gas analysis before surgery(T 0),1 h after induction(T 1),after extubation(T 2)and 1 d(T 3)after surgery.The patient s percutaneous oxygen saturation(SpO 2)at 3 d(T 4)after operation was also recorded.SpO 2,arterial oxygen partial pressure(PaO 2),arterial carbon dioxide partial pressure(PaCO 2)and oxygenation index were compared between the two groups at each time point.The incidence at 3 and 7 d after surgery between the two groups were compared.Results There was significant differences in SpO 2 between the two groups at T 2,T 3 and T 4(P<0.05).PaO 2 and oxygenation index were significantly different between the two groups at T 1,T 2 and T 3(P<0.05).The indexes of group L were higher than those of group C.The incidence of PPC in group L was significantly lower than that in group C at 3 and 7 d after surgery(P<0.05).Conclusion LPVS could improve postoperative respiratory function,improve oxygenation index and reduce the incidence of PPC in general anesthesia patients under high altitude hypoxic environment.

关 键 词：高原低氧 肺保护性通气 肝包虫病 氧合功能 术后肺部并发症 

分 类 号：R657.3[医药卫生—外科学]