肺保护性通气策略对老年胸腔镜手术患者术后转归的影响

Effect of lung protective ventilation strategy on the prognosis of elderly patients undergoing thoracoscopic surgery

目的探究肺保护性通气策略对老年胸腔镜手术患者术后转归的影响。方法 90例择期全身麻醉下行胸腔镜手术的老年患者,根据随机数字表法分为容量控制通气组(VCV组)和容量控制+肺保护性通气策略组(PV组),每组45例。比较两组患者的术中情况(麻醉时间、手术时间、晶体液输入情况、胶体液输入情况、尿量)、住院时间和并发症(呼吸衰竭、肺部感染)发生情况。结果 PV组麻醉时间(67.95±10.23)min、手术时间(60.14±8.46)min、晶体液输入量(363.00±19.75)ml、胶体液输入量(330.57±17.84)ml、尿量(184.75±8.94)ml及住院时间(5.35±1.64)d均少于VCV组的(83.53±13.46)min、(79.34±9.74)min、(440.00±23.13)ml、(428.00±26.35)ml、(254.86±13.24)ml、(8.73±2.01)d,差异均有统计学意义(P<0.05)。PV组并发症发生率13.33%明显低于VCV组的40.00%,差异有统计学意义(P<0.05)。结论肺保护性通气策略对行胸腔镜手术的老年患者有良好的作用,可改善患者术中情况及预后,有着较高的临床价值。

Objective To investigate the effect of lung protective ventilation strategy on the prognosis of elderly patients undergoing thoracoscopic surgery. Methods A total of 90 elderly patients with thoracoscopic surgery under elective general anesthesia were divided by random number table into volume-controlled ventilation group (VCV group) and volume-controlled + pulmonary protective ventilation strategy group (PV group), with 45 cases in each group. Comparison were made on intraoperative conditions (anesthesia time, operation time, crystal fluid input, colloid fluid input, urine volume), hospitalization time and occurrence of complications (respiratory failure, pulmonary infection) between the two groups. Results PV group had intraoperative anesthesia time as (67.95±10.23) min, operation time as (60.14±8.46) min, crystal fluid input as (363.00±19.75) ml/(kg·h), colloid fluid input as (330.57±17.84) ml/(kg·h), urine volume as (184.75±8.94) ml/(kg·h) and hospitalization time as (5.35±1.64) d than (83.53±13.46) min,(79.34±9.74) min,(440.00±23.13) ml/(kg·h),(428.00±26.35) ml/(kg·h),(254.86±13.24) ml/(kg·h) and (8.73±2.01) d in VCV group. Their difference was statistically significant (P<0.05). PV group had obviously lower incidence of complications as 13.33% than 40.00% in VCV group, and the difference was statistically significant (P<0.05). Conclusion Pulmonary protective ventilation strategy has a good effect on elderly patients undergoing thoracoscopic surgery, and it can improve the operation condition and prognosis of patients. It has a high clinical value.