肺超声指导个体化肺保护通气对老年患者术后肺功能及认知功能的影响  

Effect of Individualized Lung Protective Ventilation Based on Lung Ultrasound Guidance on Postoperative Lung Function Function,and Postoperative Cognitive Function in Elderly Patients

作　　者：李长松 陈鲁[3] 于大朋 刘新法 王宏刚[2] 姜琳 LI Chang-song;CHEN Lu;YU Da-peng;LIU Xin-fa;WANG Hong-gang;JIANG Lin(Yangzhou University,Yangzhou Jiangsu 225009;The Affiliated Taizhou People's Hospital of Nanjing Medical University;Taizhou Polytechnic College,Taizhou Jiangsu 225300,China)

机构地区：[1]扬州大学医学院,江苏扬州225009 [2]南京医科大学附属泰州人民医院 [3]泰州职业技术学院,江苏泰州225300

出　　处：《泰州职业技术学院学报》2024年第4期80-84,89,共6页Journal of Taizhou Polytechnic College

基　　金：2020年江苏省卫生健康委科研项目(M2020084,项目主持人:王宏刚);2020年泰州市人民医院院级科研项目(ZD202028,项目主持人:李长松);2022年南京医科大学泰州临床医学院科研项目(TZKY20220311,项目主持人:姜琳).

摘　　要：目的探讨基于肺超声指导个体化肺保护性通气对老年患者术后肺功能及术后认知功能等相关因素的影响。方法选取本院全麻腹腔镜结肠癌根治手术老年患者80例,采用数表法随机分为两组,传统的肺保护性通气组(P1组,40例)和基于肺超声实施个体化肺保护性通气组(P2组,40例)。P1组,低潮气量(VT)为6ml/Kg、持续PEEP为5cm H2O、手法膨肺(即每30min做一次维持吸气压力30cmH2O的持续肺复张15s);P2组,在P1组的基础上基于肺超声获取最佳PEEP值和肺复张膨肺压力值实施个体化肺保护性通气策略。两组分别于全麻诱导前(T0)、全麻拔管后30min(T1)、术后1d(T2)、术后3d(T3)、术后7d(T4)监测氧合指数(OI)、呼吸指数(RI)、呼吸频率(RR)、屏气时间、C-反应蛋白(CRP)浓度、简明精神状态评估(MMSE)评分、术后住院天数及术后7天内肺部并发症情况等。结果与T0时点比较,P1组T4时点OI、MMSE评分、憋气时间明显降低或缩短,RI、CRP、RR明显升高或增快(P<0.05)。与P1组比较,T1至T4时点P2组OI明显升高、RI明显降低(P<0.05);T2至T4时点P2组CRP明显降低、憋气时间明显延长、RR明显减慢(P<0.05);T3、T4时点P2组MMSE评分明显降低(P<0.05);术后住院天数P2组明显减少(P<0.05)。术后7天内肺部并发症发生率P2组[2例(5.9%)]明显降低(P<0.05)。结论基于肺超声实施个体化肺保护性通气更利于老年腹腔镜结肠癌根治术患者术后肺功能保护,对术后认知功能影响小,缩短住院时间,值得临床推荐。Objective To investigate the influence of individualized lung protective ventilation based on lung ultra⁃sound on postoperative lung function,and postoperative cognitive function in elderly patients.Methods A total of 80 elderly patients under general anesthesia were randomly divided into two groups:traditional lung protective ventilation group(P1 group,40 patients)and individualized lung protective ventilation group based on lung ultrasound(P2 group,40 patients).In P1,low tidal volume(VT)was 6 ml/Kg,continuous PEEP was 5cm H2O,and manual lung expansion.In P2,individual lung protective ventilation strategy based on lung ul⁃trasound was implemented to obtain the best PEEP value and the lung pressure value based on P1 group.Before general anesthesia induction(T0),after removing the tracheal catheter 30min(T1),postoperative 1d(T2),postop⁃erative 3d(T3)and postoperative 7d(T4),two groups were monitored for oxygen index(OI),respiratory index(RI),respiratory rate(RR),breath rate(RR),C-reactive protein(CRP)concentration,concise mental state as⁃sessment(MMSE)score,postoperative hospitalization days,and pulmonary complications within 7 days the sur⁃gery.Results Compared with the T0 point,the OI,the MMSE score and breath holding time significantly de⁃creased or shortened,while RI,CRP and RR significantly increased or increased(P<0.05).Compared with P1 group,OI and RI decreased significantly from point T1 to T4(P<0.05);CRP and P2 decreased significantly from T2 to T4(P<0.05);MMSE in P2 at point T3 and T4(P<0.05);postoperative hospitalization days P2 were significantly decreased(P<0.05).The incidence of pulmonary complications within 7 days was significantly low⁃er in P2 group(P<0.05).Conclusion Personalized lung protective ventilation based on lung ultrasound is more conducive to the protection of postoperative lung function in elderly patients with laparoscopic radical colon can⁃cer,has little impact on postoperative cognitive function,and shortens the length of hospital stay,which is wor⁃thy of clinical

关 键 词：肺超声 个体化肺保护性通气策略 老年患者 肺功能 认知功能 

分 类 号：R563[医药卫生—呼吸系统]