个体化肺保护性通气对颅脑手术患者全身麻醉肺通气效果的影响研究

On the effect of individualized pulmonary protective ventilation on general anesthesia pulmonary ventilation in patients undergoing craniocerebral surgery

摘要:

目的： 探讨个体化肺保护性通气对颅脑手术患者全身麻醉肺通气效果的影响。方法： 选取湖州市中心医院2018年7月至2019年7月收治的54例择期行颅脑手术的患者，采用随机数字表法将其分为常规组与个体化组（n=27）：常规组给予传统容量控制机械通气，个体化组给予个体化呼气末正压通气（positive end expiratory pressure，PEEP）的肺保护性通气。检测并比较麻醉诱导前（T₀）、切皮后（T₁）、机械通气1 h（T₂）、机械通气2 h（T₃）、气管拔管后30 min（T₄）血气分析、平均动脉压、肺动态顺应性，气道平台压术后1 d胸部CT，并记录患者术后7 d内肺部并发症的发生情况。结果： 与常规组相比较，个体化组患者T₁、T₂、T₃时氧合指数以及肺动态顺应性均明显高于常规组，差异有统计学意义（P<0.05）；同时T₁、T₂、T₃时气道平台压明显低于常规组，差异有统计学意义（P<0.05）。结论： 与常规通气比较，个体化肺保护性通气可以改善择期颅脑手术患者术中氧合指数、肺动态顺应性，同时降低机械通气时的气道平台压，并且安全有效。

Abstract:

Objective: To investigate the effect of individualized pulmonary protective ventilation on general anesthesia pulmonary ventilation in patients undergoing craniocerebral surgery. Methods: Fifty-four patients admitted to Huzhou Central Hospital for craniocerebral surgery from July 2018 to July 2019 were selected as the study objects. They were divided into the conventional group (n=27) and the individualized group (n=27) randomly. The conventional group was given traditional volumetric control mechanical ventilation, and the individualized group was given individualized pulmonary protective ventilation by positive end expiratory pressure (PEEP) . Blood gas analysis, mean arterial pressure, pulmonary dynamic compliance and airway platform pressure were detected and compared before anesthesia induction (T₀), after skin incision (T₁), mechanical ventilation for 1 h (T₂), for 2 h (T₃), and tracheal extubation for 30 min (T₄), and chest CT one day after surgery and the occurrence of pulmonary complications within seven days after surgery were recorded. Results: Compared with the conventional group, the oxygenation index at T₁, T₂and T₃and the lung dynamic compliance in the individualized group were significantly higher (P<0.05) . At the same time, the airway platform pressure at T₁, T₂and T₃was significantly lower than that in the conventional group (P<0.05) . Conclusion: Compared with conventional ventilation, individualized pulmonary protective ventilation can improve the intraoperative oxygenation index and dynamic compliance of lung, and reduce the airway platform pressure during mechanical ventilation, which is safe and effective.