围术期肺保护的研究进展

Research progress of perioperative lung protection

术后肺部并发症(PPCs)可引起患者术后其他脏器并发症发生率增高、住院时间延长、治疗费用增加和死亡率增高等,是影响患者预后的重要因素。肺保护具体措施涉及围术期多个环节,临床中需要对患者进行个体化的围术期管理,包括术前医护团队应及时根据患者的自身情况、手术类型和麻醉方式等对手术患者进行PPCs危险分层并制定麻醉方案;针对高风险患者采取戒烟、运动疗法、口腔护理等措施进行术前准备;术中可实施全身麻醉联合神经阻滞、呼气终末正压(PEEP)滴定、减少阿片类药物剂量、适当的肌松药和充分拮抗、中度限制性补液等肺保护策略;术后应保证完善的镇痛同时进行宣教、早期活动和肺部干预等路径。

Postoperative pulmonary complications(PPCs)can cause increased incidence of complications in other organs,longer hospital stays,increased treatment costs,and increased mortality,which are important factors affecting the prognosis of surgical patients.The measures of lung protection involve multiple links in the perioperative period,and there is an urgent need for individualized perioperative management of patients in clinical practice.The preoperative medical team should promptly carry out the risk stratification of PPCs and the selection of anesthesia methods according to the patient s own condition,type of surgery and anesthesia,measures such as smoking quitting,exercise therapy and oral care should be taken for high-risk patients to prepare for the operation,intraoperative lung protection strategies such as general anesthesia combined with nerve block,positive end-expiratory pressure(PEEP)titration,reduced opioid dose,appropriate myisolins and adequate antagonism and moderate limiting rehydration can be implemented.After surgery,education for early activities and lung intervention should be conducted.