肺保护性通气策略中通气模式对腹部手术老年患者术后肺部并发症的影响:前瞻性、随机、对照研究

Effect of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery in lung protective ventilation strategy:a prospective,randomized,controlled study

目的探讨全身麻醉术中不同通气模式对腹部手术老年患者术后肺部并发症的影响。方法选择2020年2月—2021年2月在西藏自治区人民政府驻成都办事处医院行全身麻醉上腹部手术的患者。将患者按随机数字表法分为3组:容量控制通气(volume controlled ventilation,VCV)组、压力控制通气(pressure controlled ventilation,PCV)组、压力控制-容量保证通气(pressure controlled ventilation-volume guarantee,PCV-VG)组。3组均采用国际公认的肺保护性通气策略。记录3组不同时间段的血经皮动脉血氧饱和度及呼吸力学指标以及术后7 d肺部症状体征及实验室影像学检查,并采用墨尔本肺部并发症评判法评估3组患者术后肺部并发症发生率。结果共纳入患者120例,每组各40例。3组患者的一般情况比较,差异均无统计学意义(P>0.05)。3组不同时间段的平台压和顺应性均随时间而改变(P<0.05)。3组的术后7 d发生肺部并发症、住院时间比较,差异均有统计学意义(P<0.05)。结论PCV-VG模式可减少老年患者腹部手术术后7 d肺部并发症发生率,缩短住院时间,提高患者生存质量。

Objective To investigate the effects of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery.Methods The patients who underwent upper abdominal surgery under general anesthesia in Chengdu Office Hospital of the People's Government of Tibet Autonomous Region between February 2020 and February 2021 were selected.Patients were randomly divided into volume controlled ventilation(VCV)group,pressure controlled ventilation(PCV)group,and pressure controlled ventilation-volume guarantee(PCV-VG)group according to the random number table method.All the three groups adopted the internationally recognized lung protective ventilation strategy.The transcutaneous arterial oxygen saturation and respiratory mechanics indicators of three different time periods,as well as pulmonary symptoms and signs and laboratory imaging examinations 7 days after surgery were recorded.The incidence of postoperative pulmonary complications in the three groups of patients were evaluated using the Melbourne Group Scale Version 2.Results A total of 120 patients were included,with 40 in each group.There was no statistically significant difference in the general situation of the three groups of patients(P0.05).The platform pressure and compliance of three different time periods all changed over time(P0.05).There were statistically significant differences in the occurrence of pulmonary complications and hospital stay among the three groups 7 days after surgery(P0.05).Conclusion Under the internationally recognized lung protective ventilation strategy,PCV-VG mode can significantly reduce the incidence of pulmonary complications 7 days after abdominal surgery,shorten the length of hospital stay,and improve the quality of life in elderly patients.