肺保护性通气可减轻轻中度慢性阻塞性肺疾病老年患者围术期肺部感染

发布时间：2018-06-20 20:14

本文选题：正压通气 + 慢性阻塞性肺疾病　；参考：《临床麻醉学杂志》2017年07期

【摘要】：目的探讨肺保护性通气对全麻轻中度慢性阻塞性肺疾病(COPD)老年患者围术期肺部感染的影响。方法选择择期行全麻上腹部手术的轻中度COPD老年患者40例,男24例,女16例,年龄65~81岁,ASAⅠ~Ⅲ级,BMI 19~28kg/m~2,采用随机数字表分为肺保护性通气组(PV组)和常规通气组(CV组),每组20例。PV组行肺保护通气:IPPV,V_T 6ml/kg,PEEP 5~10cm H_2O,每隔30分钟进行手法肺复张;CV组行常规通气:IPPV,V_T 10 ml/kg,不使用PEEP及肺复张。于麻醉诱导前(T_1)、机械通气后2h(T_2)、术毕时(T_3)、术后6hT_4)和24h(T_5)采集静脉血检测IL-6和IL-8的浓度;记录麻醉前、术后第1、3、5、7天的临床肺部感染评分(CPIS)和术后肺部炎症发生情况。结果两组患者年龄、BMI、ASA分级、术中输液量、出血量、尿量、机械通气时间、手术方式、T_1~T_5时IL-6和IL-8浓度组间差异均无统计学意义。与T_1时比较,T_2~T_5时两组IL-6和IL-8浓度明显升高(P0.05)。与麻醉前比较,术后第1、3、5天CV组CPIS评分和术后肺部炎症发生率明显升高(P0.05);术后第1、3、5天PV组CPIS评分明显低于CV组(P0.05)。结论肺保护性通气不能降低开腹手术轻中度COPD老年患者围术期IL-6和IL-8浓度,但是可减少术后肺部炎症的发生,减轻术后5d内的肺部感染。
[Abstract]:Objective to investigate the effect of pulmonary protective ventilation on perioperative pulmonary infection in elderly patients with mild or moderate obstructive pulmonary disease (COPD). Methods 40 elderly patients with mild or moderate COPD were selected, 24 males and 16 females, age 65~81, ASA I ~ III, BMI 19~28kg/m~2, and a random number table was divided into pulmonary protection. Ventilation group (group PV) and routine ventilation group (group CV), 20 cases of group.PV in each group were treated with pulmonary protective ventilation: IPPV, V_T 6ml/kg, PEEP 5~10cm H_2O every 30 minutes. Routine ventilation was performed in the CV group: IPPV, V_T 10. The concentration of IL-6 and IL-8 was measured by venous blood, and the clinical pulmonary infection score (CPIS) and postoperative pulmonary inflammation were recorded before anesthesia, 1,3,5,7 day after operation and postoperative pulmonary inflammation. Results there was no statistical difference between the two groups of patients' age, BMI, ASA classification, intraoperative infusion volume, amount of bleeding, urine volume, mechanical ventilation time, operation mode, and T_1~T_5 in IL-6 and IL-8 concentration groups. Compared with T_1, the concentration of IL-6 and IL-8 increased significantly in the two groups at T_2~T_5 (P0.05). Compared with before anesthesia, the CPIS score in group CV and the incidence of postoperative pulmonary inflammation increased significantly (P0.05) on the day 1,3,5 day after operation, and the CPIS score in PV group was significantly lower than that in the PV group after operation. Conclusion pulmonary protective ventilation could not reduce the mild and moderate laparotomy. Perioperative concentrations of IL-6 and IL-8 in elderly patients can reduce the incidence of postoperative pulmonary inflammation and reduce postoperative pulmonary infection in 5D.
【作者单位】：中南大学湘雅医学院附属海口医院海口市人民医院麻醉科;
【基金】：中南大学湘雅医学院附属海口医院科研项目(2016-YNJ-010-010)
【分类号】：R563.9;R614.2

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