不同氧浓度分数对肺保护通气策略下老年肥胖患者术后肺部并发症风险的影响  

Effects and risk of different FiO_(2) levels on postoperative pulmonary complications in elderly obese patients undergoing pulmonary protective ventilation strategy

作　　者：刘云洁 王超 邓伦童 Liu Yunjie;Wang Chao;Deng Luntong(Department of Anesthesiology,Jiangxi Integrated Traditional Chinese and Western Medicine Hospital,Nanchang,Jiangxi 330038,China)

机构地区：[1]江西省中西医结合医院麻醉科,江西南昌330038

出　　处：《中国药物与临床》2024年第24期1601-1605,共5页Chinese Remedies & Clinics

基　　金：江西省卫生健康委科技计划项目(202410562)。

摘　　要：目的探究吸入气中不同氧浓度分数(FiO_(2))对肺保护通气策略下老年肥胖患者术后肺部并发症风险的影响。方法选取江西省中西医结合医院45例需要气管插管全身麻醉的老年肥胖患者为研究对象,将患者以不同FiO_(2)水平分为L组(FiO_(2):30%)、M组(FiO_(2):50%)、H组(FiO_(2):70%),在相同肺保护通气策略下,比较3组气管插管即时(T0)、手术开始时(T1)、手术进行1 h后(T2)、手术结束时(T3)呼气末二氧化碳分压(PETCO_(2))、气道平台压(PPLAT)、气道峰压(PPEAK)、氧合指数(PaO_(2)/FiO_(2))、肺泡气-动脉血氧分压(PAaO_(2)),比较3组术前、手术进行1 h时、术后3 d时血气指标,并比较3组术后肺部并发症(PPCs)情况。结果T1时M组、H组PETCO_(2)、PPLAT、PPEAK、PaO_(2)/FiO_(2)、PAaO_(2)水平均差异无统计学意义(P>0.05),PETCO_(2)、PPLAT、PPEAK、PAaO_(2)水平均较L组低,PaO_(2)/FiO_(2)水平较L组高(P<0.05);T2时M组PETCO_(2)、PPLAT、PPEAK、PaO_(2)/FiO_(2)、PAaO_(2)水平较L组、H组低,PaO_(2)/FiO_(2)水平较L组、H组高(P<0.05);T3时3组PETCO_(2)、PPLAT、PPEAK水平均差异无统计学意义(P>0.05);M组PaO_(2)/FiO_(2)水平较L组、H组高,PAaO_(2)水平较L组、H组低(P<0.05);T2时M组、H组PaO_(2)水平较L组高,且M组较H组高,术后3 d时M组PaO_(2)水平较L组、H组高(P<0.05);术后3 d时L组、H组PaO_(2)水平差异无统计学意义(P>0.05);各时间点3组PaCO_(2)水平差异均无统计学意义(P>0.05);M组PPCs发生率较L组低(P<0.05);3组PPCs≥2级占比相近(P>0.05)。结论在老年肥胖患者肺保护通气策略下,FiO_(2)为50%可维持患者术中呼吸动力学稳定,改善其血气指标,且安全性良好。Objective To explore the effects of different oxygen concentration fraction in inhaled air(FiO_(2))on postoperative pulmonary complications in elderly obese patients undergoing pulmonary protective ventilation strategy.Methods A total of forty-five elderly obese patients requiring tracheal intubation and general anesthesia in Jiangxi Integrated Traditional Chinese and Western Medicine Hospital were selected as study subjects and randomly divided into Group L(FiO_(2):30%),Group M(FiO_(2):50%),and Group H(FiO_(2):70%)according to different FiO_(2) levels.Under the same lung-protective ventilation strategy,the end-tidal carbon dioxide partial pressure(PETCO_(2)),airway platform pres-sure(PPLAT),peak airway pressure(PPEAK),oxygenation index(PaO_(2)/FiO_(2)),and alveolar-arterial oxygen partial pressure difference(PAaO_(2))were compared among the three groups at the time of tracheal intubation(T0),at the beginning of surgery(T1),1 hour into surgery(T2),and at the end of surgery(T3).Blood gas indicators were com-pared among the three groups before surgery,at T2,and on the third postop-erative day.Additionally,postoperative pulmonary complications(PPCs)were compared among the three groups.Results At T1,the levels of PETCO_(2),PPLAT,PPEAK,PaO_(2)/FiO_(2),and PAaO_(2) were not statistically significant between Group M and Group H(P>0.05).Compared with Group L,both Group M and Group H had lower levels of PETCO_(2),PPLAT,PPEAK,and PAaO_(2),but higher levels of PaO_(2)/FiO_(2)(P<0.05).At T2,Group M exhibited lower levels of PETCO_(2),PPLAT,PPEAK,and PAaO_(2),and a higher level of PaO_(2)/FiO_(2) compared with both Group L and Group H(P<0.05).At T3,the levels of PETCO_(2),PPLAT,and PPEAK were not statistically significant among the three groups(P>0.05).Group M had a higher level of PaO_(2)/FiO_(2) and a lower level of PA-aO_(2) compared with Group L and Group H(P<0.05).At T2,the levels of PaO_(2) were higher in Group M and Group H compared with Group L,and Group M had a higher level than Group H.On the third postoperative day

关 键 词：肥胖症 氧浓度分数 手术后并发症 老年人 

分 类 号：R614[医药卫生—麻醉学]