围麻醉期肺保护性通气策略研究进展

Advances in strategy of lung protective ventilation during perianesthesia

近年来,随着全麻手术总量的不断增多,更多的围麻醉期机械通气相关性并发症发生率也不断提高,尤其是术前合并肺部相关性疾病及其他基础疾病的患者,机械通气相关的肺部机械性和化学性损伤更为明显,围麻醉期肺保护显得尤为重要。围麻醉期做到有效避免肺部机械通气相关并发症的发生,将明显缩短患者住院时间、改善患者预后及减少住院经济费用支出,为此如何有效应用肺保护性通气策略给我们麻醉医生提出了一个重要课题。虽然近年来肺保护性通气策略已经取得了一些进展,并被广泛应用于临床,如临床常用到的小潮气量通气、呼气末正压通气、肺复张策略及压力控制通气策略等,但不同的通气策略各有其优缺点,临床适应症也不尽明确,如何有效应用仍存在诸多争议,且肺保护性通气策略是否对围麻醉期患者产生有利影响尚无一致意见,本文将近年来肺保护性通气策略在围麻醉期的应用研究进行综述。

In recent years,with the increase of the total number of general anesthesia operations,the incidence of more complications related to mechanical ventilation during peri-anesthesia is also increasing.Especially in patients with preoperative pulmonary related diseases and other basic diseases,mechanical and chemical lung injury related to mechanical ventilation is more obvious,and pulmonary protection during peri-anesthesia is more obvious.It seems particularly important.To avoid the complications related to pulmonary mechanical ventilation effectively during perianesthesia will obviously shorten the hospitalization time,improve the prognosis of patients and reduce the cost of hospitalization.Therefore,how to effectively apply pulmonary protective ventilation strategy has raised an important issue for our anesthesiologists.Although lung protective ventilation strategies have made some progress in recent years and have been widely used in clinical practice,such as small tidal volume ventilation,positive end-expiratory pressure ventilation,lung recruitment strategy and pressure-controlled ventilation strategy,etc.,different ventilation strategies have their own advantages and disadvantages,and clinical indications are not clear.There are still many controversies about the effective use of lung protective ventilation strategy,and there is no consensus on whether it will have a beneficial impact on patients during peri-anesthesia.This article reviews the application of lung protective ventilation strategy in peri-anesthesia in recent years.