老年慢性阻塞性肺疾病患者胸腔镜手术中肺保护性通气策略的临床价值

Clinical value of lung protective ventilation strategy for thoracoscopic surgery in elderly patients with chronic obstructive pulmonary disease

目的观察老年慢性阻塞性肺疾病(简称慢阻肺)患者胸腔镜术中应用肺保护性通气策略对围术期并发症、肺氧合水平及血清炎症因子表达的影响效果。方法选取老年慢阻肺患者112例作为研究对象,患者均接受全凭静脉麻醉和胸腔镜手术,将其随机分为对照组和观察组,每组56例。对照组采用常规肺通气策略(潮气量8~10 mL/kg),观察组采用肺保护性通气策略(潮气量5~6 mL/kg,呼气末正压通气5~10 cmH 2O,平台压<30 cmH 2O)。比较2组患者围术期并发症发生率和术后住院时间,并比较2组患者手术前后肺氧合指标包括氧合指数、第1秒用力呼气容积与用力肺活量比值(FEV 1/FVC)、第1秒用力呼气容积占预计值百分比(FEV 1%)、肺泡-动脉血氧分压差[p(A-a)(O 2)]、呼气末二氧化碳分压[p et(CO 2)],血清炎症因子包括白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、γ干扰素(INF-γ)。结果观察组总并发症发生率低于对照组,术后住院时间短于对照组,差异有统计学意义(P<0.05)。术后7 d时,观察组氧合指数、FEV 1/FVC、FEV 1%和p(A-a)(O 2)水平均高于对照组,p et(CO 2)水平和血清IL-6、TNF-α、INF-γ水平均低于对照组,差异有统计学意义(P<0.05)。结论老年慢阻肺患者全身麻醉微创外科手术中应用肺保护性通气策略具有较高的临床价值,能够显著降低围术期并发症发生率,改善肺氧合水平,抑制血清炎症因子表达,促进患者快速康复。

Objective To observe the effect of protective ventilation strategy in thoracoscopic surgery on perioperative complications,pulmonary oxygenation level and expressions of serum inflammatory factors in elderly patients with chronic obstructive pulmonary disease under general anesthesia.Methods A total of 112 elderly patients with chronic obstructive pulmonary disease were enrolled as study objects,and received total intravenous anesthesia and thoracoscopic surgeries.Afterwards,they were randomly divided into control group and observation group,with 56 cases in each group.The control group was given routine pulmonary ventilation(tidal volume from 8 to 10 mL/kg).The observation group was given pulmonary protection ventilation strategy(tidal volume from 5 to 6 mL/kg,positive end-expiratory pressure from 5 to 10 cmH 2O and plateau pressure<30 cmH 2O).The incidence of perioperative complications and hospital stay after operation in the two groups were compared.Pulmonary oxygenation indicators including oxygenation index,ratio of forced expiratory volume in first second to forced expiratory volume(FEV 1/FVC),percentage of predicted FEV 1(FEV 1%),alveolar-arterial oxygen partial pressure difference[p(A-a)(O 2)],and end-expiratory partial pressure of carbon dioxide[p et(CO 2)],serum inflammatory factors including serum inflammatory factors include interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and interferon-γ(INF-γ).Results The total complication rate of the observation group was significantly lower,and the postoperative hospital stay was significantly shorter than that of the control group(P<0.05).At 7 days after operation,the oxygenation index,FEV 1/FVC,FEV 1%and p(A-a)(O 2)levels of the observation group were significantly higher than those of the control group,while the p et(CO 2)level and serum IL-6,TNF-αand INF-γlevels of the observation group were significantly lower than those of the control group(P<0.05).Conclusion The application of lung protective ventilation strategy in minimally invasive surgery of elderly patients with chronic obstructive pulmonary disease under general anesthesia has high clinical value,which can significantly reduce the incidence of perioperative complications,improve the level of pulmonary oxygenation,inhibit the expression of serum inflammatory factors,and promote the rapid recovery of patients.