肺保护性通气策略对非颅脑创伤骨折患者术后肺部并发症的影响

The effect of lung protective ventilation strategy on postoperative pulmonary complications in patients with non-cranial orthopedic trauma

目的探讨肺保护性通气策略对非颅脑骨折创伤患者术后肺部并发症(PPCs)的影响。方法纳入2023年9月至2024年1月于全麻下行创伤骨折手术患者260例,采用随机数字表法分为肺保护性通气策略组(LP组)和对照组(C组)各130例。C组采用常规通气方式,LP组采用肺保护性通气策略进行术中通气。比较两组患者术后7天内PPCs的发生及严重程度分级情况、Clavien-Dindo并发症和术中呼吸参数等。结果两组患者术中情况(如麻醉时间,手术时间,舒芬太尼、顺式阿曲库铵用量,术中晶体液、胶体液使用量,出血量以及尿量)差异无统计学意义(P>0.05)。术后7天内,两组共59例患者出现了PPCs。LP组PPCs的发生率低于C组,PPCs严重程度分级为1级例数亦少于C组(P<0.001),其余PPCs严重程度分级和Clavien-Dindo并发症分级情况差异无统计学意义(P>0.05)。机械通气1小时(T2)测定的LP组氧合指数及气道峰压大于C组,驱动压及平台压小于C组(P<0.001)。此外,两组麻醉开始前(T1)及麻醉结束拔管后30min(T3)氧合指数比较,差异均无统计学意义(P>0.05)。结论在非颅脑创伤患者全麻术中,使用肺保护性通气策略可以减少PPCs发生率,改善术中氧合,值得临床推广。

Objective To investigate the effect of lung protective ventilation strategy on postoperative pulmonary complications(PPCs)in patients with non-cranial orthopedic trauma.Methods A total of 260 patients undergoing general anesthesia for orthopedic trauma surgery from September 2023 to January 2024 were included.The patients were assigned into a lung protective ventilation strategy group(LP group)and a control group(C group)by using random number table method,130 in each group.The C group received conventional ventilation.The LP group received lung protective ventilation strategy during surgery.The incidence and severity grading of PPCs within 7 days after operation,Clavien-Dindo complications,and intraoperative respiratory parameters were compared between the two groups.Results There were no statistically significant differences in intraoperative conditions such as anesthesia duration,surgery duration,doses of sufentanil and cisatracurium,intraoperative crystalloid and clloid usage,blood loss and urine output between the two groups(P>0.05).Within 7 days after operation,a total of 59 patients in both groups developed PPCs.The incidence of PPCs in the LP group was lower than that in the C group,with less Grade 1 PPCs in the LP group(P<0.001).However,there were no statistically significant differences in the severity grades of other PPCs or in the Clavien-Dindo complications between the two groups(P>0.05).After 1 hour of mechanical ventilation(T2),the oxygenation index(OI)and the peak airway pressure in the LP group were higher than those in the C group.The driving pressure and plateau pressure were lower in the LP group than those in the C group(P<0.001).Additionally,there were no significant differences in OI between the groups at the beginning of anesthesia(T1)and after 30 minutes of extubation(T3)(P>0.05).Conclusions The use of lung protective ventilation strategy during general anesthesia in patients with non-cranial trauma can reduce the incidence of PPCs and improve intraoperative oxygenation.It is worthy of clinical application.