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
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摘要
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。
Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery.Methods90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects.According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group.The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation.Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed.ResultsThere was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups(P>0.05).The postoperative PaO2 was higher in the observation group than in the control group(P<0.05).There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time(P>0.05).The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference(P<0.05).ConclusionLung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.
Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery.Methods90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects.According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group.The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation.Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed.ResultsThere was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups(P>0.05).The postoperative PaO2 was higher in the observation group than in the control group(P<0.05).There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time(P>0.05).The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference(P<0.05).ConclusionLung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.
引文
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[9]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.
[10]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.
[11]KALLET R.Early Lung recruitment reduces pulmonary complications[J].Crit Care Alert,2017,25(4):354-455.
[12]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.
[13]SABATéS,MAZO V,CANET J.Predicting postoperative pulmonary complications:implications for outcomes and costs[J].Curr Opin Anesthesiol,2014,27(2):201-209.
[14]MAZO V,SABATéS,CANET J,et al.Prospective external validation of a predictive score for postoperative pulmonary complications[J].Anesthesiol,2014,121(2):219-231.
[15]FUTIER E,JABER S.Lung-protective ventilation in abdominal surgery[J].Curr Opin Crit Care,2014,20(4):426-430.
[16]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]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.
[3]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.
[4]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.
[5]FERNANDEZ-BUSTAMANTE A,HASHIMOTO S,NE-TO A S,et al.Perioperative lung protective ventilation in obese patients[J].BMC Anesthesiol,2015,15(1):56-56.
[6]FERNANDEZ-BUSTAMANTE A,FRENDL G,SPRUNGJ,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.
[7]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.
[8]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.
[9]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.
[10]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.
[11]KALLET R.Early Lung recruitment reduces pulmonary complications[J].Crit Care Alert,2017,25(4):354-455.
[12]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.
[13]SABATéS,MAZO V,CANET J.Predicting postoperative pulmonary complications:implications for outcomes and costs[J].Curr Opin Anesthesiol,2014,27(2):201-209.
[14]MAZO V,SABATéS,CANET J,et al.Prospective external validation of a predictive score for postoperative pulmonary complications[J].Anesthesiol,2014,121(2):219-231.
[15]FUTIER E,JABER S.Lung-protective ventilation in abdominal surgery[J].Curr Opin Crit Care,2014,20(4):426-430.
[16]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.