驱动压指导的肺保护性通气对急性Stanford A型主动脉夹层患者围手术期的效果分析

The Perioperative Efficacy of Driving Pressure-guided Lung-Protective Ventilation in Patients with Acute Type A Aortic Dissection

目的 探讨驱动压指导下的肺保护性通气在急性Stanford A型主动脉夹层(ATAAD)围手术期的应用价值。方法 选取接受全麻开胸手术的ATAAD患者,按围手术期通气策略分为驱动压指导组(D组)和常规肺保护性通气组(C组)。主要观察指标包括:围手术期发生低氧血症的次数和例数;次要观察指标包括:术后并发症、围手术期氧合分数变化趋势、术后重症监护室总滞留时间、术后有创呼吸机总辅助时间以及安全性评价。结果 D组术中驱动压显著低于C组,呼气末正压、气道峰压和动态肺顺应性均显著高于C组;术后早期氧合功能优于C组;术后肺部并发症显著少于C组,术后呼吸机辅助时间和重症监护室滞留时间也显著短于C组。结论 应用驱动压指导的肺保护性通气策略可能有助于改善ATAAD患者术后早期的氧合功能,降低术后肺部并发症的发生率,并与较短的重症监护室滞留时间和有创呼吸机辅助时间有关。

Objective To explore the perioperative efficacy of driving pressure-guided lung-protective ventilation in the patients with acute type A aortic dissection(ATAAD).Methods Patients with ATAAD who underwent open-chest surgery under general anesthesia were enrolled in this study and divided into two groups according to the perioperative ventilation strategies:the driving pressure-guided lung-protective ventilation group(group D)and the conventional lung-protective ventilation group(group C).The primary outcomes included the frequency and the incidence of the perioperative hypoxemia,and the secondary outcomes included the postoperative complications,the perioperative tendency of partial pressure of arterial oxygen/fraction of inspired oxygen ratio,the total postoperative intensive care unit stay,the total postoperative invasive ventilator-assisted time,and the safety evaluation.Results The intraoperative driving pressure in the patients of group D was significantly lower than that in group C,while the end-expiratory positive pressure,peak airway pressure,and dynamic lung compliance in the patients of group D were significantly higher.Early postoperative oxygenation function was better than in group C.Compared with group C,less cases of postoperative pulmonary complications,shorter duration of postoperative ventilation assistance and shorter length of stay in intensive care unit were observed in group D.Conclusion The application of a driving pressure-guided lung-protective ventilation strategy may contribute to improve oxygenation function in the early postoperative period in patients with ATAAD,reduce the incidence of postoperative pulmonary complications,and also be associated with shorter intensive care unit stays and invasive ventilator-assisted time.