机械通气期间通气频率对妇科开腹手术全麻患者术后肺部并发症的影响  

Effect of ventilation frequency during mechanical ventilation on postoperative pulmonary complications in patients undergoing gynecological laparotomy

作　　者：付玉杰[1] 苗杨[1] 张加强[2] FU Yu-jie;MIAO Yang;ZHANG Jia-qiang(Department of Anesthesiology,Zhengzhou Maternal and Child Health Hospital,Zhengzhou,Henan 450041,China;Department of Anesthesiology,Henan People’s Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州市妇幼保健院麻醉科,河南郑州450041 [2]河南省人民医院麻醉科,河南郑州450003

出　　处：《临床肺科杂志》2021年第11期1694-1699,共6页Journal of Clinical Pulmonary Medicine

基　　金：2019年河南省医学科技攻关计划项目(No.SB201901090)。

摘　　要：目的分析机械通气期间通气频率对妇科开腹手术全麻患者术后肺部并发症(PPCs)发病的影响。方法应用回顾性研究方法,对患者病历资料进行回顾性分析。共纳入研究对象2119人。根据患者术中通气频率分布状况分为人数大致均等的4组:组1:8~9.85次/min;组2:10~10.85次/min;组3:11~12.35次/min;组4:12.5~43.25次/min。对比分析4组患者的基线资料及术后PPCs状况。按照全部患者术后是否发生PPCs,将患者分为未发生PPCs组和发生PPCs组,应用Logistic回归分析患者术后发生PPCs的影响因素。结果患者手术后7d内共发生PPCs559例,PPCs发病率26.95%。其中,PPCs总发病率最低的是组1患者(21.36%);PPCs总发病率最高的是组3患者(33.21%)。患者术后发生最多的PPCs疾病是肺部感染,其发病率为11.14%。Logistic回归显示:年龄大、体重指数(BMI)高、慢性阻塞性肺疾病(COPD)、糖尿病、冠心病、美国麻醉医师协会(ASA)分级高、吸烟、手术时间长、术后镇痛、机械通气频率高均是患者手术后发生PPCs的显著影响因素(P<0.05),其OR值分别为:2.312、2.452、3.019、2.422、2.538、2.677、1.692、2.039、2.415、2.849。结论机械通气期间高通气频率和妇科全麻开腹手术后患者PPCs存在关联。Objective To analyze the influence of ventilation frequency during mechanical ventilation during abdominal operation on PPCs after gynecological surgery. Methods The clinical data of 2119 subjects were retrospectively analyzed. According to the distribution of ventilation frequency during operation, the patients were divided into four groups with roughly equal numbers: the group 1: 8-9.85 times/min;the group 2: 10-10.85 times/min;the group 3: 11-12.35 times/min;and the group 4: 12.5-43.25 times/min. The baseline data and postoperative PPCs status of the 4 groups were compared and analyzed. According to whether all patients had PPCs after operation, they were divided into the two groups: the no PPCs group and the PPCs group. Logistic regression was used to analyze the influencing factors of PPCs after operation. Results There were 559 cases of PPCs within 7 days after operation, and the incidence of PPCS was 26.95%. Among them, the lowest incidence of PPCs was 21.36% in the group 1. The highest incidence of PPCs was 33.21% in the group 3. Pulmonary infection was the most common PPCs disease after operation, and its incidence rate was 11.14%. Logistic regression showed that older age, high BMI, COPD, diabetes, coronary heart disease, high ASA grade, smoking, long operation time, postoperative analgesia and high frequency of mechanical ventilation were all significant influencing factors of PPCs after operation(P<0.05), and their OR values were 2.312, 2.452, 3.019, 2.422, 2.538, 2.677, 1.692, 2.039, 2.415 and 2.849 respectively. Conclusion High mechanical ventilation frequency is related to PPCs of patients after abdominal operation in general anesthesia.

关 键 词：妇科 机械通气 并发症 

分 类 号：R614.2[医药卫生—麻醉学]