保护性机械通气对开腹手术后肺功能的影响

Effects of Protective Mechanical Ventilation on Pulmonary Function after Open Abdominal Surgery

目的：探讨开腹手术期间使用保护性通气策略对于术后肺功能的恢复和肺感染的影响。方法：选择ASAⅠ~Ⅱ级择期行腹部手术的患者50例,预计手术时间大于2 h,体重指数〈25%。将患者随机分为2组：A组接受标准通气,潮气量8 m L/kg;B组接受保护性通气,潮气量为6 m L/kg,10 cm H2O PEEP以及肺复张。术后第1、3天进行肺功能实验,检测Pa O2和SPO2。术前和术后第3天进行胸部X线和肺部感染评分。结果：与A组患者比较,B组患者术后第1、3天的动脉氧合升高,且肺功能提高（P〈0.05）;术后第3天肺不张的发生率降低（P〈0.05）;术后第1、3天肺感染评分显著降低（P〈0.05）。结论：大于2 h的腹部手术中,使用保护性通气可促进术后肺功能的恢复和减少肺感染的发生。

Objective： To investigate the effect of protective mechanical ventilation during open abdominal surgery on postoperative pulmonary and Pulmonary Infection. Methods： Fifty ASAⅠorⅡpatients aged 40-65 yr BMI 〈25% scheduled for open abdominal surgery lasting more than 2 h were randomly divided into 2 groups（n=12）： standard ventilation group（group A） was assigned by envelopes to mechanical ventilation with tidal volume of 8 m L/kg. Protective ventilation（group B） was assigned by envelopes to mechanical ventilation with tidal volume of 6 m L/kg, 10 cm H2 O positive end-expiratory pressure, and recruitment maneuvers（protective ventilation strategy）. Pa O2, SPO2 and pulmonary functional tests were measured preoperatively, as well as on day 1and 3 after surgery. Modified Clinical Pulmonary Infection Score and Chest x-ray were measured on day 0 and 3. Results： Compared with group A, Patients of group B showed better pulmonary functional tests up to day 3, fewer atelectasis to day 3 and higher arterial oxygenation in air on day 1, 3. The modified clinical pulmonary infection score was lower in the protective ventilation strategy on day 3. Conclusion： A protective ventilation strategy during abdominal surgery lasting more than 2 h improved respiratory function and reduced the modified Clinical Pulmonary Infection.