肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响

来源期刊：广州医药 | 16-20 发布时间：2021-12-21 收稿时间：2025/11/13 17:37:14 阅读量：11

作者：: 黄玉侥,

卢康礼,

李观海,

何小云,

关键词：: 肺保护性通气肺功能不全胃肠手术术后转归; Lung protective ventilation strategy Pulmonary insufficiency Gastrointestinal surgery Postoperative outcome

DOI：: 10.3969/j.issn.1000-8535.2019.01.004

收稿时间：: 2018-08-05
修订日期：
接收日期：
引用总数：: 0

目的观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

1、 NIEMAN G F,SATALIN J,ANDREWS P,et al.Lung stress,strain,and energy load:engineering concepts to understand the mechanism of ventilator-induced lung injury (VILI)[J]. Intensive care med experiment,2016,4(1):1-6.

2、 FUTIER E,JABER S.Lung-protective ventilation in abdominal surgery[J]. Curr Opin Crit Care,2014,20(4):426-430.

3、 MAZO V,SABATé S,CANET J,et al.Prospective external validation of a predictive score for postoperative pulmonary complications[J]. Anesthesiol,2014,121(2):219-231.

4、 SABATé S,MAZO V,CANET J.Predicting postoperative pulmonary complications:implications for outcomes and costs[J]. Curr Opin Anesthesiol,2014,27(2):201-209.

5、彭晓慧,顾尔伟,郑立山,等. 小潮气量肺保护性通气对老年合并肺功能不全胃肠手术患者术后转归的影响[J]. 临床麻醉学杂志,2017,33(4):364-368.

6、 KALLET R.Early Lung recruitment reduces pulmonary complications[J]. Crit Care Alert,2017,25(4):354-455.

7、 GüLDNER A,KISS T,NETO A S,et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complicationsa comprehensive review of the role of tidal volume,positive end-expiratory pressure,and lung recruitment maneuvers[J]. Anesthesiol,2015,123(3):692-713.

8、屈昕. 肺保护性通气对单肺通气患者肺功能及炎性因子的影响[J]. 临床肺科杂志, 2017,22(02):364-366.

9、 NETO A S,HEMMES S N T,BARBAS C S V,et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia:a meta-analysis of individual patient data[J]. Lancet Respir Med,2016,4(4):272-280.

10、 WOODS S J,WAITE A A C,O'DEA K P,et al. Kinetic profiling of in vivo lung cellular inflammatory responses to mechanical ventilation[J]. Am J Physiol Lung Cell Mol Physiol,2015,308(9):L912-L921.

11、 FERNANDEZ-BUSTAMANTE A,FRENDL G,SPRUNG J,et al.Postoperative pulmonary complications,early mortality,and hospital stay following noncardiothoracic surgery:a multicenter study by the perioperative research network investigators[J]. Jama Surg,2017,152(2):157-166.

12、 FERNANDEZ-BUSTAMANTE A,HASHIMOTO S,NETO A S,et al.Perioperative lung protective ventilation in obese patients[J]. BMC Anesthesiol,2015,15(1):56-56.

13、 BENDER S P,PAGANELLI W C,GERETY L P,et al.Intraoperative lung-protective ventilation trends and practice patterns:a report from the multicenter perioperative outcomes group[J]. Anesth Analg,2015,121(5):1231-1239.

14、 SAHETYA S K,BROWER R G.Lung recruitment and Titrated PEEP in Moderate to Severe ARDS:Is the Door Closing on the Open Lung?[J]. Jama,2017,318(14):1327-1329.

15、 NETO A S,SIMONIS F D,BARBAS C S V,et al. Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome:a systematic review and individual patient data analysis[J]. Crit Care Med,2015,43(10):2155-2163.

16、 NEUSCHWANDER A,FUTIER E,JABER S,et al.The effects of intraoperative lung protective ventilation with positive end-expiratory pressure on blood loss during hepatic resection surgery:a secondary analysis of data from a published randomised control trial[J]. Eur J Anaesthesiol ,2016,33(4):292-298.