摘要
目的探讨不同肺通气策略对老年开腹手术患者肺功能的影响。方法选择择期在我院接受胃大部切除术的老年患者120例,随机分为常规通气组、低潮气量(VT)组及低VT+低呼气末正压通气(PEEP)+肺复张(LRM)组。常规通气组:VT为12 ml/kg;低VT组:VT为7 ml/kg;低VT+低PEEP+LRM组:VT为7 ml/kg,PEEP为5 cm H2O。记录并比较三组肺功能指标[一秒钟用力呼气量(FEV1)、用力肺活量(FVC)、呼气流量峰值(PEF)及肺活量(VC)]和各时间点血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)和呼气末二氧化碳分压(PETCO2)]。同时对比分析三组患者术后不同时间点血清炎症因子水平[肿瘤坏死因子(TNF)-α,白介素(IL)-6和巨噬细胞炎性蛋白(MIP)-1]。结果术后3 d,低VT组和低VT+低PEEP+LRM组的FEV1、FVC、PEF和VC明显高于常规通气组(P<0.05),且低VT+低PEEP+LRM组肺功能指标明显优于低VT组(P<0.05);低VT组和低VT+低PEEP+LRM组术中30、60和90 min的MAP、HR和PETCO2均低于常规通气组(P<0.05,P<0.01);低VT组和低VT+低PEEP+LRM组术中30、60 min和术后2 h TNF-α,IL-6和MIP-1的水平均低于常规通气组(P<0.05,P<0.01),低VT+低PEEP+LRM组术中60 min及术后2 h的IL-6和MIP-1水平较低VT组更低(P<0.05)。结论保护性肺通气策略(低VT+低PEEP+LRM)能减轻老年开腹手术患者术中肺损伤,改善患者肺功能和减轻炎症反应,值得临床推广应用。
Objective To explore the effect of lung ventilation strategies on pulmonary function in elderly patients with abdominal surgery. Methods A total of 120 elderly patients who underwent subtotal resection of stomach in our hospital were randomly divided into conventional ventilation group（group A）, low tidal volume（VT）group（group B）, and low VT＋low positive end expiratory pressure（PEEP）＋ lung recruitment maneuver（LRM）group（group C）. In group A, the VT is 12 ml/kg; In group B, the VT is 7 ml/kg; In group C, the VT is 7 ml/kg and the PEEP is 5 cm H2 O. The lung function index（FEV1, FVC, PEF and VC）and hemodynamic parameters（HR, MAP, SpO2 and PETCO2） of these three groups were compared and analyzed. The levels of TNF-α,IL-6 and MIP-1 in these three groups were also compared and analyzed. Results Three days after operation, the FEV1, FVC, PEF and VC in group B and group C were significantly higher than those in group A（P〈0.05）, and the improvement degree in group C was higher than that in group B（P〈0.05）. The HR, MAP and PETCO2 in group B and group C were significantly lower than those in group A at different time in operation（P〈0.05, P〈0.01）. The levels of TNF-α、IL-6 and MIP-1 were lower in group B and group C at 30 min, 60 min in operation and 2 h after operation（P〈0.05, P〈0.01）. There were significant differences in the levels of MIP-1 and IL-6 at 60 min in operation and 2 h after operation between group B and group C（P〈0.05）. Conclusion The protective lung ventilation strategy（low VT＋ low PEEP＋ LRM） proves beneficial to the recovery of elderly patient＇s lung function in clinic.
出处
《世界临床药物》
CAS
2016年第3期199-203,共5页
World Clinical Drug
基金
重庆市卫计委课题(编号:2015MSXM169)
关键词
保护性肺通气策略
开腹手术
肺功能
炎症因子
protective lung ventilation strategy
abdominal open surgery
pulmonary function
inflammatory factor
