全麻期间肺保护性通气策略的应用及前景

Application and prospect of lung protective ventilation strategy during general anesthesia

术后肺部并发症(PPC)是导致围手术期高风险的主要因素。其主要预防措施包括术前合并症的优化、戒烟及呼吸功能锻炼、贫血的纠正、术中肺保护性通气策略(LPVS)和适当的肌松药管理等,肺保护性通气的应用极为重要。因此,需要更多行之有效的LPVS来减少患者PPC的发生,提高治愈率、改善预后、缩短住院时间、减轻经济负担。近年来有许多的LPVS应用于临床,但关于小潮气量通气(LTV)、呼气末正压(PEEP)通气、肺复张策略(RM)、吸入氧浓度(FiO 2)、允许性高碳酸血症等通气模式的应用尚无定论。本文将对全麻期间LPVS进行综述。

Postoperative pulmonary complications(PPC)are the main factors leading to the high risk of surgery.The major preventive measures of PPC include optimization of preoperative complications,smoking cessation and respiratory function exercise,correction of anemia,intraoperative lung protective ventilation strategies(LPVS),and appropriate neuromuscular blocker management,etc.Among these measures,the application of lung protective ventilation is the most important one.Therefore,more effective LPVS are required to reduce the incidence of PPC,so as to improve the cure rate,improve the prognosis,shorten the length of hospital stay,and reduce the economic burden.Many LPVS have been applied in clinical practice in recent years,but there is still an open question on the application of ventilation modes such as low-tidal-volume ventilation(LTV),positive-end-expiratory pressure ventilation(PEEP),recruitment maneuvers(RM),fraction of inspired oxygen(FiO 2),permissive hypercapnia and so on.This article will review LPVS during general anesthesia.