上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

肺保护通气策略改善易感肺部并发症全身麻醉患者的价值

沈子珒1,2，董榕1,2   

  1. 上海交通大学 医学院 1.附属瑞金医院北院麻醉科， 上海 201801； 2.附属瑞金医院麻醉科， 上海 200025
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 董榕, 电子信箱: dongrong1967@yahoo.com.cn。
  • 作者简介:沈子珒（1984—）， 男， 主治医师， 硕士; 电子信箱: 13701658004@163.com。

Value of protective mechanical ventilation for alleviating symptoms of general anesthesia patients with high risk of postoperative pulmonary complications

SHEN Zi-jin1,2, DONG Rong1,2   

  1. 1.Department of Anaesthesiology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China; 2.Department of Anaesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2015-11-28 Published:2016-01-13

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摘要：

目的  探讨肺保护通气策略对术后肺部并发症高危全身麻醉手术患者呼吸力学和肺氧合功能的影响。方法  选取120例术后肺部并发症高危的全身麻醉手术患者，随机分为研究组（n=60）：潮气量 6.00 mL/kg，呼吸频率15次/min，呼气末正压 6 cmH2O，吸呼比1∶1.5，手术开始后每小时行1次肺复张，设定为自主呼吸模式，压力限定30 cmH2O，持续30 s，然后恢复至原有通气模式；对照组（n=60）：潮气量10.00 mL/kg，呼吸频率12 次/min，呼气末正压0 cmH2O，吸呼比 1∶1.5。 两组分别于机械通气30 min（T1）以及手术结束（T2）时采取动脉血测血气分析，根据结果记录氧分压、潮气量、气道峰压和平台压，计算氧合指数、肺静态顺应性和肺动态顺应性。  结果  研究组中T2时间段的平台压值明显低于对照组，肺静态顺应性和氧合指数高于对照组，术后肺部并发症发生率明显少于对照组。研究组在ICU治疗天数少于对照组（P<0.05）。结论  肺保护通气策略能够增加肺部顺应性，增加肺氧合功能，减少术后肺部并发症。

关键词: 肺保护, 肺部并发症, 机械通气

Abstract:

Objective  To explore the effects of protective mechanical ventilation on the respiratory mechanics and pulmonary oxygenation function of general anesthesia patients with high risk of postoperative pulmonary complications. Methods  A total of 120 general anesthesia patients with high risk of postoperative pulmonary complications were enrolled and randomly divided into the research group (n=60) with a tidal volume of 6.00 mL/kg, respiratory rates of 15/min, PEEP of 6 cmH2O, I∶E of 1∶1.5, one recruitment maneuver per hour after operation, spontaneous mode, pressure of 30 cmH2O for 30 s and then resuming the original mode, and the control group (n=60) with a tidal volume of 10.00 mL/kg, respiratory rates of 12/min, PEEP of 0 cmH2O, and I∶E of 1∶1.5. Arterial blood samples of two groups were drawn after mechanical ventilation of 30 min (T1) and end of operation (T2) for blood gas analysis. According to the results, oxygen partial pressure, tidal volume, peak airway pressure, and plateau pressure were recorded and oxygenation index, static compliance, and dynamic compliance were calculated. Results  Compared with the control group, the plateau pressure of the research group during T2 was significantly lower, static compliance and oxygenation index were higher, postoperative pulmonary complications were much less, and ICU stay was shorter (P<0.05). Conclusion  Protective mechanical ventilation can improve lung compliance and oxygenation and reduce postoperative pulmonary complications.

Key words: lung protection, postoperative pulmonary complications, mechanical ventilation