保护性肺通气在俯卧位手术中的应用

The use of lung protective ventilation in prone position surgery

目的观察小潮气量联合低水平呼气末正压（PEEP）对俯卧位手术患者氧合的影响。方法对50例ASAⅠ或Ⅱ级，择期在全麻下行胸腰椎手术患者，随机均分为两组，研究组A组使用保护性肺通气模式，VT=6ml／kg，PEEP=5cmH2O。对照组B组使用常规机械通气模式，VT=10ml／kg，分别监测麻醉前（T1）、俯卧位0．5h后（T2）、拔管后0．5h（T3）时的动脉血氧分压（PaO2）和术中的气道峰压（Ppeak）的变化，并计算氧合指数[PaO2／吸入氧浓度（FiO2）]的值。结果与B组比较，A组在T3时的PaO2、PaO2／FiO2显著提高（P〈0．05）。结论保护性肺通气模式有助于改善俯卧位手术患者术后氧合。

Objective To investigate the effects of lower-tidal volume and low level of PEEP in patients undergoing prone position surgery on oxygenation. Methods Fifty patients, ASA Ⅰ or Ⅱ, undergoing spina surgery. Patients were randomly assigned to two groups, the study group （ group A） was ventilated with lung-protective ventilation strategy（ VT = 6 ml/kg, PEEP = 5 cm H2O）. The control group （group B）was ventilated with conventional strategy （ VT = 10 ml/kg）. The effect of different time [ Before anesthesiology （ T1 ）, After 0. 5 hour in the prone position （ T2 ）, After tracheal extubation （ T3 ） ] on partial pressure of oxygen in artery （ PaO2 ） and Peak airway pressure （Ppeak） were observed. PaO2/inhaled oxygen concentration （ FiO2 ） was calculated. Results Compared with group B, PaO2, PaO2/FiO2 at T3 in group A was increased significantly（ P 〈 0. 05 ）. Conclusion Lung-protective ventilation strategy can improve pulmonary gas exchange in patients in the prone position.