反比通气对俯卧位腰椎后路手术肺部呼吸力学及术后并发症的影响  

Effect of Inverse Ratio Ventilation on Pulmonary Respiratory Mechanics and Postoperative Complications Undergoing Posterior Lumbar Surgery in Prone Position

作　　者：王凡 唐旺 陈丽莉 朱丽萍 樊金燕 王光磊 WANG Fan;TANG Wang;CHEN Lili(Department of Anesthesiology,The Affiliated Hospital of Xuzhou Medical University,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院麻醉科,221000

出　　处：《医学研究杂志》2023年第9期173-177,182,共6页Journal of Medical Research

摘　　要：目的评估在俯卧位下行腰椎后路手术的患者使用反比通气(inverse ratio ventilation,IRV)对肺部呼吸力学及术后并发症的影响。方法将60例ASAⅠ~Ⅱ级择期行腰椎后路手术的患者随机分为两组,即容量控制通气(volume-controlled ventilation,VCV)组和容量控制的反比通气(IRV-VC)组。麻醉诱导后所有患者先使用VCV模式,I∶E=1∶2,俯卧位后VCV组保持不变,IRV-VC组改为I∶E=2∶1。在麻醉诱导后5min(T_(0))、俯卧位5min(T_(1))、俯卧位30min(T_(2))、俯卧位1h(T_(3))以及手术结束时(T_(4))测量呼吸力学、动脉血气和血流动力学参数,并记录术后直至出院期间的肺部并发症。结果IRV-VC组在T_(2)~T_(4)的动态肺顺应性(dynamic lung compliance,Cdyn)、平均气道压(mean airway pressure,Pmean)和内源性呼气末正压(intrinsic positive end-expiratory pressure,iPEEP)均高于VCV组,气道峰压(peak airway pressure,Ppeak)和气道平台压(plateau airway pressure,Pplat)均低于VCV组(P<0.05);手术结束时动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))和氧合指数(oxygenation index,OI)高于VCV组(P<0.05),肺泡-动脉血氧分压差(alveolar-artery oxygen partial pressure gradient,A-aDO_(2))和生理无效腔率(V_(D)/V_(T))均低于VCV组(P<0.05)。两组在术后肺部并发症发生率方面差异无统计学意义(P>0.05)。结论在俯卧位行腰椎后路手术中使用IRV,可以改善肺部呼吸力学,增加氧合,但并不能减少术后肺部并发症。Objective To evaluate the effects of inverse ratio ventilation(IRV)on pulmonary respiratory mechanics and postoperative complications in patients undergoing posterior lumbar surgery in prone position.Methods Sixty patients with ASAⅠ-Ⅱundergoing elective posterior lumbar surgery were randomly divided into two groups:volume-controlled ventilation group(VCV group)and volume-controlled inverse ventilation group(IRV-VC group).After anesthesia induction,all patients initially ventilated with the VCV.After placement in the prone position,the VCV group remained unchanged,and the I∶E of IRV-VC group adjusted to 2∶1.The respiratory mechanics,arterial blood gases,and hemodynamic parameters were measured at 5min after induction of anesthesia(T_(0)),5min in prone position(T_(1)),30min in prone position(T_(2)),1h in prone position(T_(3))and at the end of surgery(T_(4)).Pulmonary complications were recorded from postoperative to discharge.Results The dynamic lung compliance(Cdyn),mean airway pressure(Pmean)and intrinsic positive end-expiratory pressure(iPEEP)of IRV-VC group at T_(2)to T_(4)were were higher than those of VCV group,while peak airway pressure(Ppeak)and plateau airway pressure(Pplat)were lower than those of VCV group(P<0.05).At T_(4),the partial pressure of oxygen in arterial blood(PaO_(2))and oxygenation index(OI)of IRV-VC group were significantly higher than those of VCV group(P<0.05),while alveolar-artery oxygen partial pressure gradient(A-aDO_(2))and V_(D)/V_(T)was lower than those of VCV group(P<0.05).There was no significant difference in the incidence of postoperative pulmonary complications between the two groups(P>0.05).Conclusion IRV could improve pulmonary respiratory mechanics and increase oxygenation,but does not reduce the incidence of postoperative pulmonary complications in patients undergoing posterior lumbar surgery in prone position.

关 键 词：反比通气 机械通气 俯卧位 腰椎后路手术 

分 类 号：R614.2[医药卫生—麻醉学]