压力控制肺复张术对老年患者腹腔镜肝切除术后肺部并发症（PPCs）的影响

Effect of pressure controlled lung recruitment on pulmonary complications （PPCs） in elderly patients after laparoscopic hepatectomy

目的探讨压力控制肺复张术对老年患者腹腔镜肝切除术后肺部并发症（PPCs）的影响。方法选择择期全身麻醉下行腹腔镜肝切除术的老年患者46例，年龄61-78岁，ASAⅡ-Ⅲ级，随机分为A组和B组，每组23例。A组患者在手术中常规控制呼吸，B组在手术过程中每隔1h25cmH2O（1cmH2O=98Pa）涨肺1min；两组患者在手术过程中其他麻醉处理均相同。记录麻醉前（T0）、拔管后（T1）、术后4h（T2）、术后24h（T3）患者的动脉血气分析结果（PaO2、PaCO2），于术后4h行B超检查有无肺不张，术后24h拍床旁胸片。结果与A组比较，B组T1、T2及T3PaO2有所升高（P〈0．05），PaCO2下降（P〈0．05）。A组术毕4h肺部B超显示肺不张发生9例（9／23），B组2例（2／23），B组肺不张发生率明显降低（P〈0．05）。术后24h床边胸片显示，A组3例（3／23）发生肺部炎症，B组0例（0／23），B组肺部炎症发生率明显降低（P〈0．05）。结论压力控制肺复张术可以减少老年患者腹腔镜肝切除术后肺部并发症（PPCs）的发生。

Objective To investigate the effect of pressure controlled lung recruitment on pulmonary complications in elderly patients after laparoscopic hepatectomy. Methods 46 elderly patients who underwent laparoscopic hepatectomy under general anesthesia, 61-78 years old and ASA classification from II to III, were randomly divided into group A and group B. During operation, group A were conventionally controlled breathing and group B pressured up lung for 1 minutes under 25 cmH2O （ 1 cmH2O=98 Pa ） every other hour and the other anesthesia treatments were the same in both groups. Before anesthesia （To）, after extubation （T1）, 4 hours after operation （T2）, and 24 hours after surgery （T3）, the patients＇ arterial blood gas analysis results （PaO2, PaCO2） were recorded. 4 hours after operation, B-ultrasonic examination was carried out. 24 hours after surgery, bedside chest radiographs was taken. Results The PaO2 at T1, T2, and T3 were higher and PaCO2 lower in B group than in group A （P 〈 0.05）. 9 cases （9/23） got atelectasis in group A and 2 （2/23） in group B （P 〈 0.05）. 3 cases （3/23） got pulmonary inflammation in group A and none in group B （P 〈 0.05）. Conclusion Pressure controlled lung recruitment can reduce the incidence of pulmonary complications （PPCs） in elderly patients after laparoscopic hepatectomy.