肺保护通气策略改善易感肺部并发症全身麻醉患者的价值被引量：7

Value of protective mechanical ventilation for alleviating symptoms of general anesthesia patients with high risk of postoperative pulmonary complications

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摘要目的探讨肺保护通气策略对术后肺部并发症高危全身麻醉手术患者呼吸力学和肺氧合功能的影响。方法选取120例术后肺部并发症高危的全身麻醉手术患者,随机分为研究组(n=60):潮气量6.00 m L/kg,呼吸频率15次/min,呼气末正压6 cm H2O,吸呼比1∶1.5,手术开始后每小时行1次肺复张,设定为自主呼吸模式,压力限定30 cm H2O,持续30 s,然后恢复至原有通气模式;对照组(n=60):潮气量10.00 m L/kg,呼吸频率12次/min,呼气末正压0 cm H2O,吸呼比1∶1.5。两组分别于机械通气30 min(T1)以及手术结束(T2)时采取动脉血测血气分析,根据结果记录氧分压、潮气量、气道峰压和平台压,计算氧合指数、肺静态顺应性和肺动态顺应性。结果研究组中T2时间段的平台压值明显低于对照组,肺静态顺应性和氧合指数高于对照组,术后肺部并发症发生率明显少于对照组。研究组在ICU治疗天数少于对照组(P<0.05)。结论肺保护通气策略能够增加肺部顺应性,增加肺氧合功能,减少术后肺部并发症。 Objective To explore the effects of protective mechanical ventilation on the respiratory mechanics and pulmonary oxygenation function of general anesthesia patients with high risk of postoperative pulmonary complications.Methods A total of 120 general anesthesia patients with high risk of postoperative pulmonary complications were enrolled and randomly divided into the research group（n = 60） with a tidal volume of6.00 mL/kg,respiratory rates of 15/min,PEEP of 6 cmH_2O,I：E of 1：1.5,one recruitment maneuver per hour after operation,spontaneous mode,pressure of 30 cmH_2O for 30 s and then resuming the original mode,and the control group（n = 60） with a tidal volume of 10.00 mL/kg,respiratory rates of 12/min,PEEP of0 cmH_2O,and I：E of 1：1.5.Arterial blood samples of two groups were drawn after mechanical ventilation of30 min（T_1） and end of operation（T_2） for blood gas analysis.According to the results,oxygen partial pressure,tidal volume,peak airway pressure,and plateau pressure were recorded and oxygenation index,static compliance,and dynamic compliance were calculated.Results Compared with the control group,the plateau pressure of the research group during T_2 was significantly lower,static compliance and oxygenation index were higher,postoperative pulmonary complications were much less,and ICU stay was shorter（P〈0.05）.Conclusion Protective mechanical ventilation can improve lung compliance and oxygenation and reduce postoperative pulmonary complications.

作者沈子珒董榕

机构地区上海交通大学医学院附属瑞金医院北院麻醉科上海交通大学医学院附属瑞金医院麻醉科

出处《上海交通大学学报（医学版）》 CAS CSCD 北大核心 2015年第11期1632-1635,共4页 Journal of Shanghai Jiao tong University:Medical Science

关键词肺保护肺部并发症机械通气 lung protection postoperative pulmonary complications mechanical ventilation

分类号 R614.2 [医药卫生—麻醉学]

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