肺保护性通气对全身麻醉下经皮肾镜手术中老年患者呼吸功能的影响

Effect of lung protective ventilation on respiratory function in middle aged and elderly patients with percutaneous renal surgery under general anesthesia

目的:探讨肺保护性通气对中老年患者经皮肾镜手术中呼吸功能的影响。方法:将60例经皮肾镜手术患者随机分为试验组和对照组各30例。试验组给予肺保护通气。观察麻醉前(T_0)、插管后截石位10 min(T_1)、改俯卧位后10 min(T_2)、1 h(T_3)、拔管后30 min(T_4)各时间点:心率(HR)、平均动脉压(MAP)、动脉血气分析、呼吸功能指标。观察术后3 d内肺部感染发生例数。结果:与对照组相比,试验组T_2、T_3、T_4的肺泡气-动脉血氧分压差(PA-a O_2)下降,Pa O_2、氧合指数(Pa O_2/Fi O_2)升高;术后3 d内肺部感染并发症减少(P<0.05)。结论:肺保护性通气策略能够减少中老年经皮肾镜手术患者术中气压伤,减少肺部感染,有利于呼吸功能的恢复。

Objective:To explore the effect of lung protective ventilation on respiratory function in middle aged and elderlypatients with percutaneous renal surgery.Methods:60 patients with percutaneous renal surgery were randomly divided into theexperimental group and the control group with 30 cases in each.The experimental group was given lung protective ventilation.Before anesthesia(T0),lithotomy position 10 minutes after intubation(T1),10 minutes after changing prone position(T2),1 hour(T3),30minutes after extubation(T4) at different time points,the heart rate(HR),mean arterial pressure(MAP),arterial blood gas analysis,respiratory function index were observed.The pulmonary infection cases were observed in postoperative 3 days.Results:Comparedwith the control group,the alveolar-arterial oxygen difference(PA-aO2) of T2,T3,T4 in the experimental group were decreased,andthe PaO2 and oxygenation index(PaO2/FiO2) were increased.The pulmonary infection complication in postoperative 3 days wasdecreased(P<0.05).Conclusion:The lung protective ventilation strategy can reduce the intraoperative air pressure injury of middleaged and elderly patients with percutaneous renal surgery,reduce the pulmonary infection,which is beneficial to the recovery ofrespiratory function.