肺保护性通气策略在房颤射频消融术中的应用

Application of lung protective ventilation strategy in radiofrequency ablation of atrial fibrillation

目的拟通过临床对照研究,观察肺保护性通气策略对于全麻下行房颤射频消融术的患者的临床意义。方法连续入选60例行房颤导管射频消融术的患者,随机分为L组(n=30)和C组(n=30)。全麻气管插管后设置呼吸参数,其中L组以6-8mL/kg设置潮气量,PEEP 5 cm H2O,间断肺复张;C组以8-10mL/kg设置潮气量。分别在插管前、通气后1h、通气后2h、术后24h采集动脉血气,术中记录P_(ET)CO_2、气道压;记录手术时间、消融时间、透视时间及手术相关并发症,记录术者满意度。术后随访患者肺部并发症情况及住院时间。结果两组患者的手术时间、透视时间、消融时间及住院时间相比,差异无统计学意义(P>0.05)。两组患者PPCs发生情况及等级差异无统计学意义(P>0.05)。两组术者满意度比较,差异有显著性(P<0.01)。结论肺保护性通气策略适合应用于全麻房颤射频消融术中通气管理。

Objective To observe the clinical significance of lung protective ventilation strategy in patients with radiofrequency ablation of atrial fibrillation under general anesthesia through clinical controlled study. Methods Sixty patients undergoing radiofrequency catheter ablation were randomly divided into group L （n=30） and group C （n=30）. Breathing parameters were set after tracheal intubation of general anesthesia.Arterial blood gas was collected. PETCO2 and airway pressure were recorded during the operation. The operative time, ablation time, fluoroscopy time and operation- related complications were recorded together with the surgeon satisfaction. Patients were followed up postoperatively for pulmonary complications. The length of patient＇s hospital-stay was recorded. Results There was no significant difference in operation time, fluoroscopy time, ablation time and hospitalization days between the two groups （P〉0.05）. There was no significant difference in the occurrence and grade of PPCs between the two groups （P〉0.05）. There was significant difference in surgeon satisfaction between the two groups （P〈0.01）. Conclusion LPVS is suitable for ventilation management in radiofrequency ablation of atrial fibrillation.