肺保护性通气策略对全麻腹腔镜手术患者氧合功能、氧化应激及术后转归的影响研究

Effect of lung protective ventilation strategy on oxygenation function,oxidative stress and postoperative out⁃comes in patients undergoing laparoscopy under general anesthesia

目的研究肺保护性通气策略对全麻腹腔镜手术患者氧合功能、氧化应激及术后转归的影响。方法回顾性分析498例腹腔镜手术患者临床资料,根据不同通气策略分为常规组(传统机械通气模式)206例与观察组(肺保护通气)292例,比较两组不同时段[麻醉后切皮前(T0)、气腹后半小时(T1)、手术开始1 h(T2)、气腹结束(T3)]的氧合指数(OI)、气道峰压(Ppeak)水平,以及手术前后的氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]、术后转归情况和术后并发症发生率。结果观察组T1、T2、T3的OI水平均高于常规组,Ppeak水平均低于常规组(t分别=2.02、3.63、3.45;-6.68、-6.46、-5.80,P均<0.05);术后观察组的MDA低于常规组,SOD高于常规组(t分别=-2.30、6.66,P均<0.05);观察组患者的下床活动时间、住院时间短于常规组(t分别=4.99、13.11,P均<0.05);观察组的术后并发症发生率为22.60%,低于常规组的30.58%(χ^(2)=4.01,P<0.05)。结论全麻腹腔镜手术患者采取肺保护性通气策略,可增强肺氧合功能,减轻氧化应激水平,有利于患者术后转归。

Objective To study the effect of lung protective ventilation strategy on oxygenation function,oxidative stress and postoperative outcomes in patients undergoing laparoscopy under general anesthesia.Methods A total of 498 patients undergoing laparoscopy were selected and divided into routine group with 206 cases and observation group with 292 cases.The routine group was received traditional mechanical ventilation mode,and the observation group received lung protective ventilation.Oxygenation index and peak airway pressure(Ppeak)level before skin incision after anesthesia(T0),0.5h after pneumoperitoneum(T1),1h after operation(T2),and end of pneumoperitoneum(T3),the oxidative stress indexes including malondialdehyde(MDA)and superoxide dismutase(SOD)before and after surgery,postoperative outcomes and incidence of postoperative complications were compared between the two groups.Results At T1,T2 and T3,OI level in observation group was higher than that in routine group,while Ppeak level was lower than that in routine group(t=2.02,3.63,3.45,-6.68,-6.46,-5.80,P<0.05).After surgery,MDA in observation group was lower than that in routine group,while SOD was higher than that in routine group(t=-2.30,6.66,P<0.05).The leaving bed time and hospitalization time in observation group were shorter than those in routine group(t=4.99,13.11,P<0.05).The incidence of postoperative complications in observation group was lower than that in routine group(22.60%vs.30.58%)(χ^(2)=4.01,P<0.05).Conclusion The application of lung protective ventilation strategy in patients undergoing laparoscopy under general anesthesia can enhance lung oxygenation function and reduce oxidative stress level,which is beneficial to postoperative outcomes of patients.