不同通气模式对老年患者腹部手术后肺部感染的影响

Effect of different ventilation modes on incidence of pulmonary infections in elderly patients after abdominal surgery

目的探讨不同通气模式对老年患者腹部手术后肺部感染的影响性,以期寻找最佳适合老年患者的通气模式,降低其术后肺部感染的发生率。方法选取2010年1月-2013年4月90例腹部手术麻醉患者为研究对象,将其分成3组,每组30例,A组为低潮气量(Vt)和低呼气末正压(PEEP),B组为高潮气量(Vt)、C组为低潮气量(Vt),观察3组患者肺部感染发生率、炎症指标变化及并发症,所得数据采用SPSS13.0软件进行分析。结果肺部感染发生率A组为3.33%、B组为20.00%、C组为6.67%;炎性因子指标肿瘤坏死因子(TNF-α)和白介素-8(IL-8)B组在手术开始后3min、机械通气3h后较其他两组升高,差异有统计学意义(P<0.05);并发症发生率A组为6.67%、B组为30.0%、C组为6.67%。结论低Vt和低PEEP能有效降低患者体内炎性因子水平,减轻患者全身炎症反应,降低肺部感染及并发症的发生。

OBJECTIVE To explore the effect of different ventilation modes on incidence of pulmonary infections in elderly patients after abdominal surgery so as to find out the most appropriate ventilation mode for the elderly patients and reduce the incidence of postoperative pulmonary infections. METHODS A total of 90 patients, who underwent abdominal anesthesia surgery from Jan 2010 to Apr 2013, were enrolled in the study and divided into three groups, with 30 cases in each; the group A received the ventilation with low tidal volume （Vt）and low positive end-expiratory pressure （PEEP）, the group B received the ventilation with high tidal volume（Vt）, and the group C received the ventilation with low tidal volume, then the incidence of pulmonary infections, change of inflammatory markers, and incidence of complications were observed and compared between the three groups, and the obtained data were statistically analyzed with the use of SPSS13. 0 software. RESULTS The incidence of pulmonary infections was 3.33M in the group A, 20.00~ in the group B, 6.67M in the groups C; as compared with other two groups, the levels of the inflammatory cytokines indicators such the tumor necrosis factor （TNF-~） 6.67% in the group A, 30.0% in the group B, 6.67~ in the group C. CONCLUSION The low tidal volume and low PEEP can effectively reduce the levels of the inflammatory cytokines, relieve the systemic inflammations, and decrease the incidence of pulmonary infections or complicatlons. Key words：