机械通气模式对老年人腹腔镜术后肺功能的影响

Effects of mechanical ventilation modes on postoperative pulmonary function in aged patients undergoing laparoscopic surgery

目的 比较三种机械通气方法对术前有或无肺部疾病的老年人施行腹腔镜手术术后肺氧合功能及术后肺部并发症的影响.方法 择期行腹腔镜E腹部手术的老年患者104例,术前无肺部疾病66例,有肺部疾病38例,随机分为六组：无肺部疾病的患者分为A、B,C三组（n=20、20、26）,有肺部疾病的患者分为D、E、F三组（n=10、13、15）.A组和D组术中使用间歇正压通气（IPPV）,术后使用同步间歇指令通气（SIMV）;B组和E组术中使用呼气末正压通气（PEEP）,术后使用SIMV;C组和F组术中IPPV,术后使用SIMV＋持续气道内正压通气（CPAP）.记录麻醉前、注气后3 h、注气后4 h、拔管后45 min、术后第1、2、3天的MAP、HR、血气分析结果及术后第7天内肺部并发症的情况.结果 与麻醉前比较,注气后六组的动脉血氧分压（PaO2）、肺泡动脉氧分压差（A-aDO2）均增高;拔管后各组的PaO2降低、A-aDO2均增高（P〈0.05或P〈0.01）.C组术后第1天、A和B组术后第2天、F组术后第3天各项氧合指标恢复;D和E组术后第3天仍未恢复.C组术后肺部并发症发生率低于A组,F组低于D组（P〈0.05）.结论 腹腔镜手术后用CPAP,能改善老年患者肺氧合功能,减少肺部并发症.

Objective To compare the effects of three different mechnical ventilation modes on the postoperative pulmonary oxygenation and postoperative pulmonary complications in aged patients undergoing laparoscopic surgery with or without preoperative pulmonary diseases. Methods One hundred and four aged patients undergoing selective upper abdominal taparoscopic surgery, including 66 patients without and 38 patients with preoperative pulmonary diseases, were randomized into 6 groups： patients without preoperative pulmonary disease allocated to groups A, B, and C （n=20, 20, and 26, respectively）, and patients with preoperative pulmonary disease allocated to groups D, E, and F （n= 10, 13, and 15, respectively）. Patients in groups A and D received intermittent positive-pressure ventilation （IPPV） intraoperatively followed by simultaneous intermittent mandatory ventilation （SIMV） postoperatively. Patients in groups B and E received positive end expiratory pressure （PEEP） intraoperatively followed by SIMV operatively. Patients in groups C and F received IPPV intraoperatively followed by SIMV and continuous positive airway pressure （CPAP）. postoperatively. Mean arterial pressure （MAP）, heart rate （HR）, and blood gas analysis preanesthesia, 3 h, 4 h after insufflation, 45 rain after tracheal extuhation, and 1, 2, and 3 d after operation, respectively, and postoperative pulmonary complications （PPCs） in postoperative 7 days were recorded, Results Compared with preanesthesia, arterial oxygen tension （PaO2）, and alveolar-arterial oxygen difference （A-aDO2） increased intraoperatively; and PaO2 decreased while A-aDO2 increased in all groups （P〈 0. 05 or P〈 0. 01 ）. Indices of oxygenation recovered completely in group C 1 day after operation, in groups A and B 2 days after operation, and in group F 3 days after operation. While the indices did not recover in groups D and E 3 days after operation, PPCs had a lower incidence in group C than group A, and in group F than group D （P〈0. 05）. Conclusion CPAP ventilation after laparoscopy may improve pulmonary oxygenation and reduce PPCs in aged patients.