个体化肺保护性通气对长时间颅脑手术患者全身麻醉肺通气效果的影响  

Effect of individualized lung protective ventilation on pulmonary ventilation under general anesthesia in patients undergoing long-term craniocerebral surgery

作　　者：王钱荣[1] 周燕[1] 姚搏炜 龚浩杰[1] 陈烨 乔双 沈佳莹 芮雯婷 WANG Qianrong;ZHOU Yan;YAO Bowei(Department of Anesthesiology,Huzhou Central Hospital,Huzhou 313000,CHINA)

机构地区：[1]湖州市中心医院麻醉科,浙江313000

出　　处：《江苏医药》2023年第6期577-582,共6页Jiangsu Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020KY306)。

摘　　要：目的探讨个体化肺保护性通气对长时间颅脑手术患者全身麻醉肺通气效果的影响。方法84例择期行颅脑手术患者随机均分为传统组与个体组。两组均实施潮气量+呼气末正压(PEEP)+间断肺复张容量控制机械通气;传统组给予7 cmH_(2)O水平PEEP,个体组给予个体化PEEP通气的肺保护性通气策略。记录麻醉诱导前(T0)、切皮后(T1)、机械通气1 h(T2)、机械通气2 h(T3)、气管拔管后30 min(T4)和术后第1天上午6:00(T5)的氧合指数、PaCO_(2)、HR、MAP、肺动态顺应性(Cdyn)和气道平台压(Pplat)。结果T0~T3时,两组MAP和HR比较均无统计学差异(P>0.05)。T3时,个体组氧合指数高于传统组(P<0.05),其他时间点两组间比较均无统计学差异(P>0.05)。T0~T5时,两组PaCO_(2)相比均无统计学差异(P>0.05)。T1~T3时,个体组Cdyn均高于传统组(P<0.05);T3时,个体组Ppalt低于传统组(P<0.05),T1和T2时两组间Ppalt相比无统计学差异(P>0.05)。结论与传统肺保护性通气比较,个体化肺保护性通气可以改善长时间颅脑手术患者Cdyn,降低Ppalt的同时改善患者氧合能力。Objective To explore the effect of individualized lung protective ventilation on the lung ventilation efficacy of general anesthesia in the patients undergoing long-term craniocerebral surgery.Methods Eighty-four patients undergoing elective craniocerebral surgery were randomly divided into two groups of A and B with 42 cases each.The ventilation mode of low tidal volume+positive end expiratory pressure(PEEP)+intermittent lung recruitment volume controlled mechanical ventilation was performed in both groups,during which PEEP 7 cmH_(2)O was used in group A and the lung protective ventilation strategy of individualized PEEP ventilation was used in group B.The oxygenation index,PaCO_(2),HR,MAP,lung dynamic compliance(Cdyn),and airway flat table pressure(Pplat)were recorded as the time points of before anesthesia induction(T0),after skin incision(T1),after mechanical ventilation for 1 hour(T2),after mechanical ventilation for 2 hours(T3),30 minutes after tracheal extubation(T4),and at 6:00 am(T5)on the first day after surgery.Results There were no significant differences in MAP and HR between the two groups at T0 to T3(P<0.05).The oxygenation index at T3 was higher in group B than that in group A(P<0.05),which was not significantly different between the two groups at the other time points(P<0.05).There was no significant difference in PaCO_(2) between the two groups at T0 to T5(P<0.05).At T1 to T3,Cdyn in group B was higher than that in group A(P<0.05).Ppalt of group B at T3 was lower than that of group A(P<0.05),which was not statistically difference between the two groups at T1 and T2(P<0.05).Conclusion Compared with traditional lung protective ventilation,individualized lung protective ventilation can improve Cdyn,reduce Ppalt,and improve oxygenation in the patients undergoing long-term craniocerebral surgery.

关 键 词：呼吸末正压 肺动态顺应性 颅脑手术 

分 类 号：R614[医药卫生—麻醉学]