摘要
目的：观察肺保护性通气策略联合肺复张对全身麻醉开腹手术患者围手术期肺功能和氧分压的影响。方法将70例择期行开腹手术患者按随机数字表法分为标准通气组（潮气量8 ml/kg）和保护性通气组（潮气量6 ml/kg，5 cmH2O呼气末正压通气及肺复张手法，1 cmH2O=0.098 kPa），每组35例。观察术中气道压、血压、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）和不良反应发生情况。测定患者术前和术后1、3、5 d SpO2、动脉血氧分压（PaO2）和肺功能。结果保护性通气组呼吸频率、气道压和PETCO2高于标准通气组[（12.3±2.1）次/min比（10.2±1.0）次/min、（15.1±2.8）cmH2O比（13.5±2.3）cmH2O、（34.6±2.1）mmHg（1 mmHg=0.133 kPa）比（32.1±1.4）mmHg]，差异有统计学意义（P＜0.05）。两组术中SpO2均维持在0.99。两组术中并发症发生情况比较差异无统计学意义（P＞0.05）。保护通气组术后1、3 d SpO2和PaO2明显高于标准通气组[0.951±0.018比0.936±0.016、0.964±0.018比0.949±0.018和（74.8±6.8）mmHg比（65.0±6.2）mmHg、（79.6±6.0）mmHg比（70.6±5.3）mmHg]，差异有统计学意义（P＜0.05）。保护性通气组术后1、3、5 d第1秒用力呼气容积（FEV1）、FEV1占预计值百分比、用力肺活量（FVC）和FVC占预计值百分比明显高于标准通气组，术后1 d FEV1/FVC明显高于标准通气组，差异有统计学意义（P＜0.05）。结论肺保护性通气策略联合肺复张对全身麻醉患者术后肺功能和氧分压有改善作用。术中应用小潮气量，适当的PEEP和肺复张手法对全身麻醉手术患者肺部具有一定的保护作用。
Objective To observe the improvement of postoperative pulmonary function and oxygen partial pressure during general anesthesia for open abdominal surgery with lung protective ventilation strategies and alveolar recruitment maneuvers. Methods Seventy patients who underwent selective open abdominal surgery were selected, and they were divided into standard ventilation group （tidal volume 8 ml/kg） and protective ventilation group （tidal volume 6 ml/kg, 5 cmH2O positive end-expiratory pressure, and alveolar recruitment maneuvers, 1 cmH2O=0.098 kPa） according to the random digits table method with 35 cases each. The airway pressure, blood pressure, pulse oxygen saturation （SpO2）, end-tidal partial pressure of carbon dioxide （PETCO2） and adverse reactions were observed. The SpO2, partial pressure of O2 （PaO2） and pulmonary function before surgery and 1, 3, 5 d after surgery were measured. Results The respiratory rate, airway pressure and PETCO2 levels in protective ventilation group were significantly higher than those in standard ventilation group： （12.3 ± 2.1） times/min vs. （10.2 ± 1.0） times/min, （15.1 ± 2.8） cmH2O vs. （13.5 ± 2.3） cmH2O, （34.6 ± 2.1） mmHg （1 mmHg=0.133 kPa） vs. （32.1 ± 1.4） mmHg, and there were statistical differences （P〈0.05）. The SpO2 in 2 groups was maintained at 0.99. There was no statistical difference in the incidence of postoperative complications between 2 groups （P〈0.05）. The SpO2 and PaO2 levels at 1, 3 d after surgery in protective ventilation group were significantly higher than those in standard ventilation group：0.951 ± 0.018 vs. 0.936 ± 0.016 and 0.964 ± 0.018 vs. 0.949 ± 0.018, （74.8 ± 6.8） mmHg vs. （65.0 ± 6.2） mmHg and （79.6 ± 6.0） mmHg vs. （70.6 ± 5.3） mmHg, and there were statistical differences （P〈0.05）. The forced expiratory volume in 1 s （FEV1）, percentage of the estimated value of FEV1, forced vital capacity （FVC） and percentage of the estimated value of FVC at 1, 3 an
出处
《中国医师进修杂志》
2016年第8期711-715,共5页
Chinese Journal of Postgraduates of Medicine
关键词
肺通气
麻醉
全身
肺功能
肺复张
Pulmonary ventilation
Anesthesia,general
Pulmonary function
Alveolar recruitment maneuvers
