不同通气策略对严重肺功能不全脊柱侧凸矫形手术患者肺顺应性、氧合功能及术后早期感染指标的影响  

Effects of different ventilation strategies on lung compliance,oxygenation function and early postoperative infection in patients undergoing scoliosis orthopaedic surgery with severe pulmonary insufficiency

作　　者：齐磊 张科 刘梅 于明帅 陈祖棋 刘思远 QI Lei;ZHANG Ke;LIU Mei;YU Mingshuai;CHEN Zuqi;LIU Siyuan(Department of Anesthesiology,Second Affiliated Hospital of Chengdu Medical College,Chengdu 610051,China)

机构地区：[1]成都医学院第二附属医院核工业四一六医院麻醉科,四川成都610051

出　　处：《陕西医学杂志》2024年第4期496-499,504,共5页Shaanxi Medical Journal

基　　金：四川省成都市医学科研课题(2020139)。

摘　　要：目的:探究不同通气策略在合并严重肺功能不全脊柱侧凸矫形手术患者中的应用比较。方法:选择择期拟行脊柱侧凸矫形手术合并肺功能不全患者,按术中通气策略方式的不同分为保护性肺通气策略A组(PA组)、保护性肺通气策略B组(PB组)、常规通气策略组(C组);监测不同时间点呼吸参数、动脉血气;计算动态肺顺应性(Cdyn)、驱动压(DP)、氧合指数(OI);监测术后第1、3、7天的静脉血白介素6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)以及第7天肺感染评分等指标。结果:术中C组DP明显高于PA、PB组,术后不同时间点IL-6、CRP比较,C组明显高于PA、PB组,术后第1天OI明显低于PA、PB组(均P<0.05)。PA、PB组间比较,各时点Cdyn、DP、OI、炎症因子及肺感染评分比较差异无统计学意义(均P>0.05)。结论:术中保护性肺通气策略有助于降低严重肺功能不全脊柱侧凸矫形手术患者气道压力,减轻术后炎症反应并保护残余肺功能。Objective:To observe the application of different ventilation strategies in patients with severe pulmonary insufficiency and scoliosis undergoing orthopedic surgery.Methods:Patients with pulmonary insufficiency who planned to undergo orthopedic surgery for scoliosis were divided into protective lung ventilation strategy group A(PA group),protective lung ventilation strategy group B(PB group)and conventional ventilation strategy group C(C group)according to the different intraoperative ventilation strategies;espiratory parameters and arterial blood gas were monitored at different time points;Dynamic lung compliance(Cdyn),driving pressure(DP)and oxygenation index(OI)were calculated;Serum interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT)and pulmonary infection score on the 1st,3rd and 7th day were monitored.Results:During operation,DP in group C was significantly higher than that in groups PA and PB.IL-6 and CRP in group C were significantly higher than those in groups PA and PB at different time points after surgery,and OI in group C was significantly lower than that in group PA and PB on the first day after surgery(all P<0.05).There were no significant differences in Cdyn,DP,OI,inflammatory factors and pulmonary infection scores between PA and PB groups at each time point(all P>0.05).Conclusion:Intraoperative protective lung ventilation strategy can reduce airway pressure,reduce postoperative inflammatory response and protect residual lung function in patients with severe pulmonary insufficiency and scoliosis undergoing orthopaedic surgery.

关 键 词：机械通气 保护性肺通气策略 脊柱侧凸 肺顺应性 肺氧合 炎症因子 

分 类 号：R682.3[医药卫生—骨科学]