全麻中保护性通气策略对老年上腹部大型手术患者术后肺脏功能的影响

The Effects of Intraoperative Protective Ventilation Strategy on Postoperative Lung Function

目的 比较全麻手术过程中应用保护性通气策略与传统通气对老年上腹部大型手术术后肺脏功能的影响.方法 前瞻性队列研究,研究入选42例患者(年龄≥65岁,手术时间≥2h):分为保护性通气策略组21例,术中采用保护性通气方法,潮气量:5 ~6 ml/kg(采用理想体重计算),呼气末正压(PEEP) 5cmH2O和周期性肺复张方法;传统通气组21例,术中采用传统通气方法,潮气量:10~12 ml/kg(采用理想体重计算).观察术后患者第1d、3d (d1、d3)氧合;术后d1、d3、d5、d7肺功能;术后d1或d2胸片改变;术后肺部并发症;术后住院时间和死亡情况.结果 保护性通气策略组较传统通气组术后胸片渗出改变减少(P<0.05);术后严重肺部并发症发生降低(P<0.05);其他观察指标两组间差异无统计学意义(P>0.05).结论 保护性通气策略对减轻老年上腹部大型手术患者术后肺脏损伤可能有益.

Objective To compare the effects of protective ventilation strategy and traditional ventilation on lung function in older patients undergoing major abdominal surgery. Methods 42 patients (≥65 years old, the operation time≥2 hours) were involved in the prospective cohort study. The patients were divided into the protective ventilation strategy group (Tidal volume : 5~6 ml/kg, PEEP 5cm H20 and periodic recruitment maneuvers) and traditional ventilation group (Tidal volume: 10 ~ 12 ml/kg). The oxygenation, spirometries, chest radiograph images, pulmonary complications, hospital stay and death were recorded. Results Compared with traditional ventilation group, postoperative chest radiograph showed less infiltration changes (P< 0.05 ) and the incidence of severe postoperative pulmonary complications were significantly reduced ( P < 0.05 ) in the protective ventilation strategy group. There were no significant differences in others indexes between the two groups ( P> 0.05 ). Conclusion Protective ventilation strategy is beneficial to reduce lung injury in older patients undergoing major abdominal surgery.