小潮气量及呼气末正压联合手法肺复张对老年患者肺功能的影响

Effect of low tidal volume and positive end-expiratory pressure combined with alveolar recruitment maneuvers on pulmonary function of elderly patients

目的观察小潮气量及呼气末正压通气联合手法肺复张,对全身麻醉老年患者肺功能及相关并发症的影响。方法将60例择期行单侧膝关节置换的老年患者随机分为标准通气组(C组)和保护性通气组(L组),每组30例。检测并记录两组患者不同时点(术前及术后)动脉血氧分压、二氧化碳分压、气道压力,观察术中血流动力学变化及术后呼吸系统并发症,检测术前及术后1、3、5天肺功能。结果两组术前Pa O_2组间比较无差异,而术后Pa O_2均明显低于术前,但L组明显高于C组[(80.2±3.4)mm Hg(1 mm Hg=0.133k Pa)比(74.1±2.6)mm Hg],差异有统计学意义(P=0.0437,P<0.05)。两组患者术前FEV_1、FVC、FEV_1/FVC组间比较无差异,术后1、3、5天FEV_1、FVC、FEV_1/FVC组内比较均较术前降低,而术后L组以上指标则明显高于C组,差异有统计学意义(P<0.05)。结论术中应用小潮气量、适度呼气末正压联合手法肺复张可以改善老年患者术后呼吸功能,具有一定的保护作用。

Objective To observe the effect of low tidal volume and positive end-expiratory pressure combined with alveolar recruitment maneuvers on pulmonary function and related complications of elderly patients during general anesthesia.Methods 60 elderly patients who underwent selective unilateral knee replacement surgery were selected,and they were randomly divided into the standard ventilation group(the C group)and the protective ventilation group(the L group).The different time(preoperative and postoperative)partial pressure of O 2,pressure of CO 2 and airway pressure were measured,the hemodynamic changes and postoperative respiratory complications were observed,and the pulmonary function before surgery and 1,3,5 d after surgery were also measured.Results There was no statistical difference between the two groups in PaO 2 before operation,but both groups showed significantly lower PaO 2 than it before operation.The PaO 2 level after surgery in the L group were significantly higher than those in the C group(80.2±3.4)mmHg(1 mmHg=0.133 kPa)vs.(74.1±2.6)mmHg(P=0.0437,P<0.05).There was no statistical difference between the two groups in FEV 1,FVC and FEV 1/FVC before operation.The levels of FEV 1,FVC and FEV 1/FVC 1,3,5 d after operation of the two groups were significantly lower than those before operation,and those in the L group were significantly higher than those in the C group(P<0.05).Conclusion The application of low tidal volume in operation,moderate PEEP combined with alveolar recruitment maneuvers have certain protective effects on postoperative pulmonary function in elderly patients.