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

发布时间：2018-01-26 14:35

本文关键词： 肺保护肺部并发症机械通气　出处：《上海交通大学学报(医学版)》2015年11期 　论文类型：期刊论文

【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 m L/kg,呼吸频率15次/min,呼气末正压6 cm H2O,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 cm H2O,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 m L/kg,呼吸频率12次/min,呼气末正压0 cm H2O,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(P0.05)。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。
[Abstract]:Objective to investigate the effects of lung protective ventilation strategy on high risk of postoperative pulmonary complications of general anesthesia in patients with respiratory mechanics and oxygenation function. Methods 120 cases of postoperative pulmonary complications in high-risk patients with general anesthesia, were randomly divided into study group (n=60): m L/ kg 6 tidal volume, respiratory rate 15 /min, exhale at the end of the positive pressure of 6 cm H2O, respiratory ratio of 1 to 1.5 for every 1 hours after the start of surgery for pulmonary reexpansion, setting independent breathing patterns, pressure is limited to 30 cm H2O for 30 s, and then return to the original ventilation mode; the control group (n=60): 10 m L/kg tidal volume, respiratory rate 12 /min, 0 cm H2O positive end expiratory pressure, breath ratio of 1: 1.5. two group were 30 min mechanical ventilation (T1) and the end of operation (T2) to measure arterial blood gas analysis, according to the records of the results of oxygen partial pressure, tidal volume, peak airway pressure and platform pressure, oxygenation index calculation, the static lung compliance and lung Dynamic compliance. Results T2 time period in the study group platform pressure value was significantly lower than the control group, static lung compliance and oxygenation index higher than the control group, the incidence of postoperative pulmonary complications was significantly less than the control group. The study group were less than the control group in the treatment of ICU (P0.05). Conclusion lung protective ventilation strategy can increase lung compliance, increase oxygenation, reduce postoperative pulmonary complications.

【作者单位】：上海交通大学医学院附属瑞金医院北院麻醉科;上海交通大学医学院附属瑞金医院麻醉科;
【分类号】：R614.2
【正文快照】： 肺保护通气策略在急性呼吸窘迫综合征患者可以减轻或者防止机械性肺损伤,而对于全身麻醉(简称全麻)手术患者围手术期应用是否具有肺保护作用,减少术后肺部并发症还有待研究。本研究选择术后易感肺部并发症全麻手术患者,采用常规通气与保护性通气进行比较,以探讨肺保护通气策略

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