低潮气量联合不同阶段呼气末正压通气对老年患者开腹术后肺功能的影响

目的观察术中低潮气量联合不同阶段呼气末正压通气(positive end expiratory pressure,PEEP)对老年患者开腹术后肺功能及并发症的影响。方法选择择期全麻下行开腹手术的老年患者60例,男21例,女39例,年龄≥65岁,ASAⅠ或Ⅱ级,随机分为三组,每组20例。A组手术开始后1h联合PEEP 10cm H_2O持续1h,B组术毕拔除气管导管前1h联合PEEP 10cm H_2O持续1h,C组手术全程联合PEEP 10cm H_2O。分别于术前、术后1、24h行血气分析测PaCO_2、PaO_2和A-aDO_2,计算氧合指数。记录术前、术后24、72h的气道分泌物评分。结果与术前比较,术后1h三组PaCO_2明显升高,B组PaO_2明显下降,A组A-aDO_2明显升高(P0.05);术后24hB组、C组PaCO_2明显升高,B组氧合指数明显下降(P0.05)。与术后1h比较,术后24hA组PaCO_2明显下降,A组A-aDO_2明显下降(P0.05)。术后三组气道分泌物评分差异无统计学意义。结论术中低潮气量联合不同阶段PEEP能够改善术后肺的氧合功能,但对术后肺部并发症无明显影响。

Effect of ventilation with low tidal volume and positive end-expiratory pressure in different periods on postoperative pulmonary function and short-term prognosis in elderly patients with abdominal surgery

Objective To observe the effects of ventilation with low tidal volume and positive end-expiratory pressure (PEEP) in different periods on the postoperative pulmonary function and short-term prognosis in aged patients undergoing abdominal surgery. Methods Sixty aged patients undergoing selective open abdominal surgery scheduled for general anesthesia, 21 males and 39 females, were randomized into 3 groups (n=20). Patients in group A received PEEP 1 h after the beginning of surgery; patients in group B received PEEP 1 h before tracheal extubation; patients in group C received PEEP intraoperatively.The secretion score in preoperative, postoperative 24h and 72h respectively, and the arterial blood gas analysis indexes (PaCO2,PaO2,A-aDO2, PaO2/FiO2 calculation) in postoperative 1 h and 24 h were recorded. Results Compared with preoperative, in postoperative 1 h,PaCO2 increased obviously in all groups, PaO2 decreased in groupB, A-aDO2 increased in group A (P<0.05); in postoperative 24 h, PaCO2 was significantly increased in group B and C, PaO2/FiO2 decreased in group B (P<0.05). Compared with postoperative 1 h, in postoperative 24 h, PaCO2 and A-aDO2 decreased obviously in group A (P<0.05). There were no differences in postoperative secretions score in between the 3 groups. Conclusion Low tidal volume combined short-range PEEP in different periods of surgery may improve postoperative pulmonary oxygenation. But they had no obvious help with postoperative pulmonary complications.