喉罩联合保护性通气策略对患者术后血清SPA的影响

Effect of Protective Ventilation Strategy with Laryngeal Mask Airway on Postoperative Serum SPA

目的探讨喉罩联合肺保护性通气策略对患者术后血清SPA的影响。方法选择择期全麻开腹手术患者76例,年龄18～65岁,ASA Ⅱ～Ⅲ级,所有患者随机分成两组:喉罩常规通气组(LH组,n=38)和喉罩保护性通气组(LP组,n=38)。LH组采用喉罩常规通气,VT8～10mL/kg,不使用PEEP和手控肺复张; LP组使用喉罩保护性通气,V_T6～8ml/kg,PEEP 5cmH_2O,每半小时一次手控肺复张。记录放置喉罩和拔出喉罩时的心率、血压变化;于手术开始前(T_1),机械通气1小时(T_2),手术结束时(T_3)抽动脉血进行血气分析,记录这3个时间点的气道峰压;术前和术后第2天抽静脉血用ELISA方法检测肺表面活性蛋白A(SP-A);记录术后3天体温、咳嗽/咳痰、肺部听诊情况及相关并发症,术后7天内肺部并发症(postoperative pulmonary complications,PPCs)的发生情况,患者满意度及术后住院天数。术后30天内患者死亡率。结果 16例被剔除,60例纳入最终的分析。两组患者30天内无患者死亡,主要通气指标、术后发热、咳嗽咳痰、术后住院时间、满意度差异无统计学意义; LH组与LP组插入和拔出喉罩时平均动脉压和心率上升值比较,差异无统计学意义(P>0.05);血清SP-A含量两组术前无差异,术后第2天LH组明显高于术前和同时段的LP组,差异有统计学意义(P<0.05); LH组发生PPCs较LP组多,LH组发生4例,LP组发生1例,但发生率差异无统计学意义。结论在全麻开腹手术中,联合使用喉罩和保护性通气策略有减少术后PPCS的趋势,可以明显降低患者患者术后血清SPA的浓度。

Objective To discuss the effect of laryngeal mask airway combined with lung protective ventilation on postoperative serum SPA.Methods 76 patients who underwent elective laparostomy operations under general anesthesia,aging from 18 to 65 years,with ASA II^III grade,were selected and randomly divided into 2 groups:the group of routine ventilation with laryngeal mask airway(LH group,n=38)and the group of protective ventilation with laryngeal mask group(LP group,n=38).The LH group received routine ventilation with laryngeal mask airway,with VT8~10ml/kg,without PEEP or hand-controlled pulmonary reexpansion;the LP group were given protective ventilation with laryngeal mask airway,VT6~8ml/kg,PEEP 5cmH2O,with pulmonary reexpansion every half an hour.Changes in heart rate and blood pressure during laryngeal mask airway placement and removal were recorded;the arterial blood was taken for blood gas analysis before operation(T1),mechanical ventilation for 1 hour(T2),and at the end of operation(T3),and the airway peak pressure at these three time points were recorded;The venous blood was taken to detect pulmonary surfactant-associated proteins A(SP-A)by ELISA before and 2 days after operation;And the temperature,cough/expectoration,pulmonary auscultation and related complications 3 days after operation,postoperative pulmonary complications(PPCs)within 7 days after operation,patient satisfaction,postoperative hospital stay and mortality rate in 30 days after operation were recorded.Results Sixteen patients were excluded and 60 were included in the final analysis.No patients died within 30 days in the 2 groups,and there was no statistically significant difference in major ventilation indexes,postoperative fever,cough and sputum,postoperative hospital stay and satisfaction;comparison of mean arterial pressure and heart rate rise between the LH group and the LP group when the laryngeal mask was inserted and removed showed no significant difference(P>0.05);there was no difference in serum SP-A content between the 2 groups before operation,while the serum SP-A content in LH group on the second day after operation was significantly higher than that in the LP group before operation and at the same time,the difference was statistically significant(P<0.05);PPCs occurred more in the LH group than in the LP group,4 cases in the LH group and 1 case in the LP group,but the difference was not statistically significant.Conclusion In laparostomy operations under general anesthesia,the combined use of laryngeal mask and protective ventilation strategies tend to reduce postoperative PPCS,which can significantly reduce the postoperative serum SPA concentration of patients.