肺复张策略在全身麻醉术后患者的早期应用

Early application of lung recruitment maneuver in patients after general anesthesia

目的 探讨肺复张策略（LRM）在全身麻醉术后患者早期应用的效果.方法 选取2012年1月至12月入住天津医科大学总医院重症医学科的非开胸手术的全身麻醉患者356例作为研究对象,在全身麻醉术后早期实施LRM.对患者LRM前后的氧合指数、肺顺应性及收缩压情况进行比较,并根据年龄（＜35岁,35～ 65岁,＞65岁）及麻醉时间（＜3 b,3～6h,＞6 h）分别对患者进行分组,以研究其对LRM前后氧合指数差值的影响.结果 LRM前后患者的氧合指数、肺顺应性及收缩压之间的比较差异均有统计学意义（P均＜0.05）.不同麻醉时间的患者,LRM前后氧合指数差值比较差异均有统计学意义（P均＜0.05）,而不同年龄的患者,仅在年龄＜ 35岁组与年龄35 ～ 65岁组和年龄＞65岁组之间比较,差异有统计学意义（P均＜0.05）.结论 LRM在全身麻醉术后患者的早期应用可以提高患者的肺顺应性和氧合指数,且中老年患者及麻醉时间长的患者更应给予LRM.

Objective To investigate the effect of early application of lung recruitment maneuver （LRM） on patients after general anesthesia. Methods A total of 356 patients with non-thoracotomy from January to December, 2012 hospitalized in the intensive care unit, Tianjin Medical University General Hospital were enrolled in the study. All the cases received LRM in the early after general anesthesia. The oxygenation index, pulmonary compliance and systolic pressure were measured before and after the LRM. Then the patients were further divided into three groups according to age （younger than 35 years, 35- 65 years old, older than 65 years） and anesthesia time （〈 3 h, 3- 6 h, 〉 6 h）, respectively, and the oxygenation index differences among the three groups were compared. Results The oxygenation index, pulmonary compliance were higher, and the systolic pressure was lower after the LRM （all P 〈 0.05）. Meanwhile, the oxygenation index difference before and after the LRM in patients with different anesthesia time all had significant differences （all P〈 0.05）, and statistically significant differences were observed only in the younger than 35 years old group compared with the 35-65 years old group and older than 65 years old group （all P 〈 0.05）. Conclusion Early application of LRM in patients after general anesthesia can improve the patient＇s pulmonary compliance and oxygenation index, especially in the elder patients and patients with a long duration of anesthesia