保护性肺通气对老年肺癌患者肺叶切除术围术期肺功能的影响

Abstract
Figure/Table
References (22)
Related Citation (15)

Download: PDF (480 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To evaluate the effect of lung protective ventilation strategies on the pulmonary function and postoperative pulmonary complications in elderly patients with pulmonary lobectomy. Methods A total of 60 elderly patients with lung cancer of ASA physical status Ⅰ-Ⅱ, aged 62-72 year, weighing 50-80 kg, who underwent elective pulmonary lobectomy surgery in Municipal Hospital of Qingdao from January to December 2014 were seleced. All patients were divided into two groups (n=30): protective ventilation group (group PV) and conventional ventilation group (group CV) according to random number table. In group CV, patients received volume-controlled ventilation and the VT was 10 mL/kg. In group PV, patients received pressure-controlled ventilation, the VT was 6 mL/kg, and the positive end-expiratory pressure (PEEP) was 6 cmH2O. The oxygen concentration was 100%, the inhalation and exhalation rate was 1∶2, and the partial pressure of end-tidal CO2 was 35-45 mmHg. The peak inspiratory pressure (PIP) and the plateau pressure (PPleatu) were compared and analyzed at the time of double lung ventilation (TLV) 15 min (T1), one-lung ventilation (OLV) 15 min (T2), OLV 60 min (T3), and the restore TLV 15 min (T4). The time from stopping anesthetic to extubating tracheal tube was also recorded and compared. Blood samples were collected from radial artery for blood gas analysis, the PaCO2 and PaO2 were compared and analyzed at the time of T1, T2, T3, T4, 2 h after pulmonary lobectomy surgery (POD0), the morning of 1 days after surgery (POD1) and the morning of 2 days after surgery (POD2). Chest X-ray in two groups was also compared and analyzed in POD2. Results There were no significant differences between the two groups in sex, age, weight, smoking history, preoperative pulmonary function, anesthesia time, operation time, surgical approach and duration of postoperative tracheal intubation (P ＞ 0.05). Compared with group CV, PIP, PPleatu and PaO2 were significantly decreased, PaCO2 was increased at T2, T3 in group PV, with statistically significant differences (P ＜ 0.05). Compared with group CV, PaO2 levles were significantly increased in group PV at POD0, POD1, POD2, with statistically significant differences (P ＜ 0.05). Compared with group CV, the incidence of postoperative pulmonary atelectasis, pulmonary infiltrates were significantly decreased in group PV (P ＜ 0.05). Conclusion The protective lung ventilation strategy can significantly reduce intraoperative mechanical ventilation pressure, improve postoperative pulmonary oxygenation function, reduce incidence rate of postoperative atelectasis and lung tissue infiltrates of elderly patients underwent pulmonary lobectomy.

Key words： Lung protective ventilation Pulmonary lobectomy One lung ventilation Pulmonary function

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2017/V14/I20/120

[1] Lin F，Pan L，Qian W，et al.Comparison of three ventilatory modes during one-lung ventilation in elderly patients[J].Int J Clin Exp Med，2015，8（6）：9955-9960.
[2] Choudhuri AH，Chandra S，Aggarwal G. Predictors of posto?鄄perative pulmonary complications after liver resection：Results from a tertiary care intensive care unit [J]. Indian J Crit Care Med，2014， 18（6）：358-362.
[3] 许俊，金守兵，陈东方，等.对进行机械通气的急性肺损伤患者实施控制性肺膨胀治疗的效果研究[J].当代医药论丛，2015（2）：277-278.
[4] Hemmes SN，Serpa Neto A. Intraoperative ventilatory strate?鄄gies to prevent postoperative pulmonary complications：a meta-analysis [J]. Curr Opin Anaesthesiol，2013，26（2）：126-133.
[5] 周彩存.NCCN 2008年非小细胞肺癌临床实践指南更新[J].肿瘤，2008，28（3）：183-186.
[6] 王邵华，阮征，郑健，等.肺切除术后肺部并发症发生的危险因素分析[J].中国胸心血管外科临床杂志，2010，17（4）：301-306.
[7] 查本俊，吴志云，王永盛.保护性肺通气方式在单肺通气患者中的应用[J].临床军医杂志，2009，37（6）：1121-1122.
[8] Michelet P，D'Journo XB，Roch A，et al. Protective ventilation influences systemic inflammation after esophagectomy： a randomized controlled study [J]. Anesthesiology，2006，105（5）：911-919.
[9] Patel JM，Baker R，Yeung J，et al. Intra-operative adherence to lung-protective ventilation：a prospective observational study [J]. Perioperat Med，2016，5（1）：8.
[10] 李孝建，钟晓旻，邓忠远，等.肺保护性通气策略联合肺复张对严重烧伤并发急性呼吸窘迫综合征患者的疗效[J].中华烧伤杂志，2014，30（4）：305-309.
[11] 徐志礼.允许性高碳酸血症的器官保护及应用策略[J].临床肺科杂志，2011，16（3）：432-434.
[12] Wang C，Wang X，Chi C，et al. Lung ventilation strategies for acute respiratory distress syndrome： a systematic review and network meta-analysis [J]. Sci Rep，2016，6：22855.
[13] Bicer C，Esmaoglu A，Akin A. Dexmedetomidine and mep?鄄eridine prevent postanaesthetic shivering [J]. Eur J Anaes?鄄thesiol，2006，23（2）：149-153.
[14] 赵双，曾玲双，邢学宁.低潮气量机械通气在全身麻醉中的应用[J].现代医药卫生，2014，30（4）：493-494.
[15] Yang WC，Song CY，Wang N，et al. Hypercapnic acidosis confers antioxidant and anti-apoptosis effects against ven?鄄tilator-induced lung injury [J]. Laborat Invest，2013，93（12）：1339.
[16] Yang M，Ahn HJ，Kim K，et al. Does a protective vent?鄄ilation strategy reduce the risk of pulmonary complica?鄄tions after lung cancer surgery? A randomized controlled trial [J]. Chest，2011，139（3）：530-537.
[17] 何明枫，陈宇.允许性高碳酸血症对单肺通气后肺功能及萎陷侧肺炎症反应的影响[J].临床麻醉学杂志，2015， 31（12）：1172-1175.
[18] 崔显念.支气管肺泡灌洗液中3种肿瘤标志物的检测在肺癌诊断及病情评估中的价值[J].中国医药科学，2015， 5（9）：130-132.
[19] Kozian A，Schilling T，Schütze H，et al. Ventilatory protective strategies during thoracic surgery： effects of alveolar rec?鄄ruitment maneuver and low-tidal volume ventilation on lung density distribution [J]. Anesthesiology，2011，114（5）：1025-1035.
[20] 于洪秀，董慧，苏芬菊，等.临床护理路径在肺癌全肺切除术围术期中的价值[J].中国医药科学，2016，6（7）：153-155.
[21] Nichol AD，O'Cronin DF，Naughton F，et al. Hypercapnic acidosis reduces oxidative reactions in endotoxin-induced lung injury [J]. Anesthesiology，2010，113（1）：116-125.
[22] Güldner A，Kiss T，Serpa Neto A，et al. Intraoperative protective mechanical ventilation for prevention of posto?鄄perative pulmonary complications：a comprehensive review of the role of tidal volume，positive end-expiratory pressure，and lung recruitment maneuvers [J]. Anesthesiology，2015， 123（3）：692-713.