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

doi:10.3969/j.issn.1006-6233.2018.02.009

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Abstract Objective: To provide guidance for the patients with anesthesia ventilation in the selection process by understanding of gastrointestinal surgery used in lung protective ventilation with low tidal volume to the elderly pulmonary insufficiency results and analysis of the method of difference between the traditional mechanical ventilation. Methods: From February 2012 to December 2016, 140 cases of gastrointestinal surgery admitted in our hospital were randomly divided into control group (traditional mechanical ventilation group) and experimental group (protective ventilation management group), with 70 patients in each group. The operation related indicators (Pplat, Ppeak, PErCO₂, Raw, anesthesia time, operative time, operative bleeding volume, transfusion volume and urine volume) of the two groups before and after operation (T₀-T₄) were compared. The statistical difference of airway monitoring index, oxygen saturation and related indicators (PaO₂, PaCO₂, OI, Qs/Qt), inflammatory cytokines and related indicators (IL-6, IL-8, TNF-α, CC16, SP-D, sRAGE) of two groups were compared. Results: The differences of Pplat, PErCO₂, Raw, time of anesthesia, operation time and bleeding volume of the two groups were statistically significant (P<0.05). The Pplat, PErCO₂ and Raw in the experimental group were larger than those in the control group, and the time of anesthesia, the operation time and the amount of bleeding were less than those of the control group. The difference of P peak, P average and CL index in the experimental group and the control group was statistically significant (P<0.05). The difference of P peak (T₁, T₂, T₃), P average (T₂, T₃), CL (T₂, T₃, T₄) between the two groups were statistically significant (P<0.05). The overall index of the experimental group was less than that of the control group. The differences of PaO₂, PaCO₂, OI and Qs/Qt in the experimental group and the control group were statistically significant (P<0.05). The differences of PaO₂ (T₂, T₃, T₄), PaCO₂ (T₁, T₂, T₃, T₄) and Qs/Qt between the two groups were statistically significant. The PaO₂, PaCO₂, OI and Qs/Qt in the control group were less than those in the experimental group. The differences of IL-6, IL-8, TNF- alpha, CC16, SP-D and sRAGE in the experimental group and the control group were statistically significant (P<0.05). The difference of IL-6 (T₁, T₂), TNF- alpha (T₁, T₂, T₃, T₄), CC16 (T₁, T₂, T₃), and the index of between the two groups were statistically significant. The TNF-alpha, CC16 and SP-D in the control group were higher than those in the experimental group, but the sRAGE was less than the experimental group. Conclusions: Gastrointestinal surgery in elderly patients with pulmonary insufficiency, lung protective ventilation of low tidal volume, compared to conventional mechanical ventilation can reduce the severity of inflammation, better protect the airway function and blood gas status and safety of anesthesia.

Key words： Small tidal volume ventilation Protective ventilation Old age Pulmonary dysfunction Gastrointestinal surgery

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	GAO Dehong

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GAO Dehong. Effect of Small Tidal Air Volume Lung Protective Ventilation on PostoperativeReintegration of Catients with Incomplete Gastroenteral Surgery for Elderly combined with Pulmonary Dysfunction[J]. HeBei Med, 2018, 24(2): 215-222.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2018.02.009 OR http://www.hbyxzzs.cn/EN/Y2018/V24/I2/215

[1] 张学琴.泌尿外科腔镜手术对老年人肺功能的影响及肺保护性通气策略的应用[J].中国妇幼健康研究,2017,2:100~101.
[2] 黄壮荣,章海波,祝曙光,等.保护性(单)肺通气在肺癌麻醉中的应用[J].广东医学,2017,38(15):2353~2354,2358.
[3] Long Y , Liu DW . The conception of circulation protective ventilation strategy[J]. Zhonghua Nei Ke Za Zhi ,2016 ,55(3): 172~174.
[4] 谭义文,田毅,魏晓,等.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[J].临床麻醉学杂志,2017,33(7):660~663.
[5] 李娟,张维,陈宇,等.肺保护性通气对膝关节置换术中氧合功能及肺顺应性影响[J].武警医学,2017,28(7):668~671.
[6] 蔡恒宇,郜红艳.肺保护性通气策略在妇科腹腔镜手术中应用的临床观察[J].实用妇产科杂志,2017,33(7):534~537.
[7] 董兰,安丽娜,岳阳,等.肺保护性通气对肝移植手术患者肺损伤血清生物标志物和炎性因子的影响[J].临床麻醉学杂志,2017,33(6):525~528.
[8] 李立英,李炜,陈永学,等.压力-容积曲线指导呼气末正压对全身麻醉单肺通气下开胸患者的保护作用分析[J].三峡大学学报(自然科学版),2017,39(1):55~59.
[9] Fischer MO,Courteille B,Guinot PG,et al. Perioperative ventilatory management in cardiac surgery: a french nationwide survey[J]. Medicine (Baltimore) ,2016,95(9): 2655.
[10] 李榕,李勇,李冰冰.肺保护性通气策略对长时间腹腔镜手术老年患者呼吸功能的影响[J].贵州医药,2017,41(5):483~485.
[11] 宋邵华,田惠玉,杨秀芬,等.气道压力释放通气对急性呼吸窘迫综合征患者的临床应用观察[J].中国医刊,2017,52(5):26~30.
[12] Ball L , Pelosi P . Intraoperative mechanical ventilation in patients with non-injured lungs: time to talk about tailored protective ventilation[J]. Ann Transl Med ,2016,4 (1):17.
[13] 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.
[14] 赵志刚.肺保护性通气策略对妇科腔镜手术患者肺功能的影响[J].四川医学,2017,38(3):311~315.
[15] 谭华,吴畏.肺保护性通气策略研究进展[J].西南国防医药,2017,27(2):212~214.
[16] 吕晓春,赵恩宽,邢陆祥.肺保护性通气策略在老年慢性阻塞性肺疾病患者手术中的应用[J].中国医刊,2017,52(2):104~106.
[17] 温晓敏,朱小燕.呼吸机治疗新生儿呼吸窘迫综合征的肺保护性分析[J].河北医药,2017,39(2):190~193.
[18] 杨子莹,黄宁,陈祖博.麻醉诱导期使用肺保护性通气对妇科腔镜手术氧饱和度的影响[J].现代诊断与治疗,2017,28(1):138~140.
[19] 徐广,郭海明,卜慧莲,等.肝移植术中肺保护性通气策略对术后肺部感染及肺功能、氧化应激的影响研究[J].中华医院感染学杂志,2016,26(22):5159~5162.
[20] 徐悦利,李汝泓,李玲,等.肺保护性通气策略联合反复肺复张在食管癌切除术中的应用[J].山东医药,2016,56(38):47~49.
[21] Barbas CS,Serpa Neto A. New puzzles for the use of non-invasive ventilation for immunosuppressed patients[J].Thorac Dis ,2016,8 (1):100~103.
[22] 白利群,兰元丹,张兵,等.保护性机械通气对开腹手术后肺功能的影响[J].现代生物医学进展,2015,15(27):5257~5259,5267.
[23] 袁庆杰.肺保护性通气策略治疗肺内和肺外源性急性呼吸窘迫综合征的临床对比[D].青岛大学,2015.
[24] 孙雪青.保护性肺通气策略对开胸手术食管癌患者肺功能的影响[D].郑州大学,2015.
[25] 任惠龙.保护性肺通气策略对开胸患者氧化应激及术后肺部并发症的影响[D].北京市结核病胸部肿瘤研究所,2015.
[26] 舒六一,吴妮,赖丽芬,等.保护性通气模式对上腹部肿瘤手术患者肺功能恢复的影响[J].海南医学,2015,26(5):661~663.