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

小潮气量联合肺复张策略对老年患者腹部手术后早期肺部感染的影响

丁雯 1，沈亮 1，项明洁 1，俞淙轶 1，陆志俊 2   

  1. 1.上海交通大学 医学院附属瑞金医院卢湾分院麻醉科，上海 200020；2. 上海交通大学 医学院附属瑞金医院麻醉科，上海 200025
  • 出版日期:2016-11-28 发布日期:2016-11-29
  • 通讯作者: 陆志俊，电子信箱：lusamacn@126.com。
  • 作者简介:丁雯（1983—），女，主治医师，学士；电子信箱：wendy_ding@icloud.com。
  • 基金资助:

    上海市黄浦区科技项目（HKW201458）

Effects of low tidal volume mechanical ventilation and lung recruitment maneuver on early pulmonary infection after abdominal operations in elderly patients

DING Wen1, SHEN Liang1, XIANG Ming-jie1, YU Cong-yi1, LU Zhi-jun2   

  1. 1. Department of Anesthesiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China; 2.Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2016-11-28 Published:2016-11-29
  • Supported by:

    Science and Technology Project of Huangpu District of Shanghai，HKW201458

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摘要：

目的 ·探讨全身麻醉期间运用小潮气量联合肺复张策略对老年患者腹部手术后早期肺部感染的影响。方法 ·择期行胃、肠道手术（≥2 h）的老年患者60例（ASA Ⅰ～Ⅱ级），年龄60～75岁，随机分为保护性通气组和常规通气组，每组各30例。常规通气组以潮气量8 mL/kg IBW，保护性通气组以潮气量6 mL/kg IBW和呼气末正压通气（PEEP）5 cm H2O，并联合肺复张策略，常规麻醉诱导下气管内插管，进行机械通气，初始频率为12次/min，维持潮气量不变，根据EtCO2调整呼吸频率。记录术前和术后24 h血气分析指标（PH、PO2、PCO2、HCO3-和氧合指数）、临床肺部感染评分（CPIS）、降钙素源（PCT）和C反应蛋白（CRP），以及术中不良事件。结果 ·术后24 h保护性通气组CPIS、CRP明显低于常规通气组，而PCT、血气指标和术中不良事件发生率无明显差异。结论 ·小潮气量联合肺复张策略能降低老年患者术后早期CPIS和CRP，降低术后早期肺部感染发生危险。

关键词: 小潮气量, 老年患者, 临床肺部感染评分, 降钙素源, C反应蛋白

Abstract:

Objective · To investigate the effects of applying low tidal volume mechanical ventilation and lung recruitment maneuver during general anesthesia on early pulmonary infection after abdominal operations in elderly patients. Methods · Sixty elderly patients (ASAⅠ-Ⅱ) aged 60-75 years undergoing elective
digestive tract operations ( ≥2 h) were randomly assigned to the standard ventilation group and the protective ventilation group with 30 cases in each group.
The standard ventilation group received a tidal volume of 8 mL/kg ideal body weight and zero-positive end-expiratory pressure. The protective ventilation
group received a tidal volume of 6 mL/kg ideal body weight, 5 cm H2O positive end-expiratory pressure (PEEP), and recruitment maneuvers pressure. Patients underwent conventional induction of anesthesia, endotracheal intubation, mechanical ventilation with an initial respiratory rate of 12 breaths/min and a stable tidal volume. The respiratory rate was adjusted according to EtCO2. Blood gas analysis parameters (PH, PO2, PCO2, HCO3-, oxygenation index), clinical pulmonary infection score (CPIS), procalcitonin (PCT), and C-reactive protein (CRP) were recorded before and 24 h after operation. Intraoperative adverse events were also documented. Results · CPIS and CRP 24 h after operation were significantly lower in the protective ventilation group than in the standard ventilation group. However, no significant differences in PCT, blood gas analysis parameters, and intraoperative adverse events were found. Conclusion · Low tidal volume mechanical ventilation and recruitment maneuver can reduce early postoperative CPIS and CRP, and the risk of early postoperative pulmonary infection in elderly patients.

Key words: low tidal volume, geriatric patients, clinical pulmonary infection score, procalcitonin, C-reactive protein