老年患者重大手术后肺复张疗效观察

目的 观察肺复张(RM)对老年患者重大手术后肺不张及肺部感染的预防作用并评价其安全性.方法 选择2007年2月-2008年2月北京空军总医院重症加强治疗病房(ICU)收治的70岁以上老年患者40例,均为重大手术后,全麻手术持续6 h以上,麻醉、肌松状态入ICU,均为有创动脉压监测.随机分为RM试验组和非RM对照组,RM条件为吸入氧浓度0.60,呼吸频率20次/min,潮气量5 ml/kg,呼气末正压25 cm H2O(1 cm H2O=0.098 kPa),吸呼比1∶2,持续30 s,1 h后重复1次.记录RM前、后2 min及RM实施过程中心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、气道平台压(Pplat)、脉搏血氧饱和度(SpO2)的变化;RM前及末次RM 1 h后进行动脉血气分析;观察两组患者肺不张及肺部感染发生情况.结果 ①RM操作中HR、MAP、CVP有显著变化(P均<0.05),但未影响循环功能.②RM后2 min CVP迅速恢复,RM操作前后比较HR、MAP、CVP、SpO2变化不明显(P均>0.05);RM后Pplat显著降低(P<0.05).③RM组实施RM后肺不张、肺部感染的发生率均显著低于非RM组(P均<0.05).④RM后氧合指数较前变化明显(P<0.05).结论 RM可预防老年患者重大手术后肺不张及肺部感染的发生,RM在老年患者中使用较安全,并可明显改善老年患者氧合指数.

Effects of recruitment maneuver on elderly patients after major operations

OBJECTIVE: To study the effect of recruitment maneuver (RM) in preventing atelectasis and lung injury in elderly patients after major operations, and to evaluate the safety of RMs. METHODS: Forty elderly patients after major operations were admitted to intensive care unit (ICU) of Beijing Air Force General Hospital from February 2007 to February 2008 were randomized into RM group and control group. The patients were still under the effect of anesthesia and muscle relaxation when admitted. All of them were under invasive blood pressure monitoring, which was continued for over 6 hours. RM was conducted by regulating inspired oxygen concentration (FiO2) to 0.60, respiratory rate 20/min, tidal volume (VT) 5 ml/kg, with 25 cm H2O (1 cm H2O=0.098 kPa) of continuous positive end-expiratory pressure (PEEP) for 30 seconds, and then the previous ventilator setting was resumed. The above modality was repeated once after 1 hour. Heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), platform airway pressure (Pplat), percutaneous oxygen saturation (SpO2) were measured before and after the RM. Arterial blood gas analysis was done before and after RMs. The presence of pulmonary atelectasis or pulmonary infection was looked for after RMs. RESULTS: (1) There were significant changes in HR, CVP and MAP during RM (all P<0.05), circulation function was not affected. (2) There were no significant changes in HR, MAP, CVP and SpO2 before and after RMs (all P>0.05). Pplat was significantly reduced after RMs (P<0.05). (3) The incidence of pulmonary atelectasis or pulmonary infection was significantly lower in RM group (both P<0.05). (4) Oxygenation index (PaO2/FiO2) in RM group was significant increased (P<0.05) . CONCLUSION: RM is safe when used in elderly patients. It can significantly improve oxygenation in elderly patients.