喉罩联合肺保护性通气策略对开腹手术患者肺功能肺部并发症及血清SP-A含量的影响

Effect of Laryngeal Mask Combined with LPSV on Pulmonary Function Pulmonary Complications and Serum SP-A in Patients Undergoing Laparotomy

目的:观察喉罩联合肺保护性通气策略(LPSV)对开腹手术患者肺功能、肺部并发症及血清肺表面活性蛋白质A(SP-A)的影响。方法:前瞻性地选取2018年7月至2020年7月我院普外科行择期开腹术的60例患者作为研究对象,以随机数字表简单随机随机分成两组,对照组(30例)为LPSV,观察组为喉罩联合LPSV(30例)。收集临床指标、肺功能指标、肺部并发症、血清生化因子,并比较。结果:两组患者临床指标比较差异无统计学意义(P>0.05)。对照组术后通气指标最大通气量(MVV)、用力肺活量(FVC)及换气指标最大呼气流量(PEF)、用力呼气25%流速(FEF25)均显著低于术前,观察组换气指标FEF25显著低于术前,差异均有统计学意义(P<0.05);观察组MVV、FVC、FEV1、PEF、FEF25术后及差值均显著高于对照组,差异有统计学意义(P<0.05)。观察组肺部感染、胸腔积液及肺不张发生率为3.33%、0%、0%,显著低于对照组的23.33%、13.33%、13.33%,差异有统计学意义(P<0.05)。两组患者术后1d血清SP-A均显著高于术前、术后7d,差异有统计学意义;术后1d、术后7d观察组血清SP-A水平均显著低于对照组,差异有统计学意义(P<0.05)。结论:喉罩联合PCV可降低肺功能损伤,降低肺部并发症发生率,且能降低血清SP-A水平。

Objective:To observe the effects of laryngeal mask combined with LPSV on lung function,pulmonary complications and serum SP-A in patients undergoing laparotomy.Methods:60 patients who underwent elective laparotomy in General Department of our hospital from July 2018 to July 2020 were selected as the study object prospectively.The patients in the control group(30 cases)were divided into two groups randomly and simply by random,the control group(30 cases)as LPSV,and the observation group was laryngeal mask combined with LPSV(30 cases).The clinical indexes,pulmonary function indexes,pulmonary complications,serum biochemical factors were collected and compared.Results:There was no significant difference in clinical indexes between 2 groups(P>0.05).Ventilation indexes MVV,FVC,ventilation indexes PEF and FEF25 in the control group were significantly lower than those before surgery,the differences were statistically(P<0.05).Ventilation indexes FEF25 in the observation group were significantly lower than those before surgery,the differences were statistically significant(P<0.05).Ventilation indexes MVV,FVC,FEV1,ventilation indexes PEF and FEF25 in observation group were significantly higher than those in control group,the differences were statistically significant(P<0.05).The incidence of pulmonary infection,pleural effusion and atelectasis in the observation group were 3.33%,0%,0%,significantly lower than that in the control group 23.33%,13.33%,13.33%,the differences were statistically significant(P<0.05).Serum SP-A in 2 groups on day 1 after surgery was significantly higher than that before surgery and 7 days after surgery,the differences were statistically significant(P<0.05).The level of serum SP-A in the observation group was significantly lower than that in the control group on day 1 and day 7 after surgery,the differences were statistically significant(P<0.05).Conclusion:Laryngeal mask combined with PCV can reduce lung function injury,lung complication rate,and serum SP-A level.