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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
- 重庆医科大学学报 2022年47卷第5期 页码：572-576
- 作者机构：
1.浙江大学附属第二医院麻醉科，杭州 310009
2.湖州市中心医院麻醉科，湖州 313000
- 作者简介：
王钱荣，Email：wqr0101030@163.com，研究方向：围术期肺保护性通气研究。
郁丽娜，Email：zryulina@zju.edu.cn。
- 基金信息：
DOI：10.13406/j.cnki.cyxb.002836
中图分类号： R614.2纸质出版日期：2022-05-28，
收稿日期：2020-10-09，
扫 描 看 全 文
王钱荣, 郁丽娜, 周燕, 等. 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[J]. 重庆医科大学学报, 2022,47(5):572-576.
Qianrong Wang, Lina Yu, Yan Zhou, et al. On the effect of individualized pulmonary protective ventilation on general anesthesia pulmonary ventilation in patients undergoing craniocerebral surgery[J]. Journal of Shanxi Agricultural Sciences, 2022,47(5):572-576.
王钱荣, 郁丽娜, 周燕, 等. 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[J]. 重庆医科大学学报, 2022,47(5):572-576. DOI： 10.13406/j.cnki.cyxb.002836.
Qianrong Wang, Lina Yu, Yan Zhou, et al. On the effect of individualized pulmonary protective ventilation on general anesthesia pulmonary ventilation in patients undergoing craniocerebral surgery[J]. Journal of Shanxi Agricultural Sciences, 2022,47(5):572-576. DOI： 10.13406/j.cnki.cyxb.002836.
摘要
目的：
2
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：
2
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（T
0
）、切皮后（T
1
）、机械通气1 h（T
2
）、机械通气2 h（T
3
）、气管拔管后30 min（T
4
）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：
2
与常规组相比较，个体化组患者T
1
、T
2
、T
3
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T
1
、T
2
、T
3
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：
2
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
:
2
To investigate the effect of individualized pulmonary protective ventilation on general anesthesia pulmonary ventilation in patients undergoing craniocerebral surgery.
Methods
:
2
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 (T
0
)
after skin incision (T
1
)
mechanical ventilation for 1 h (T
2
)
for 2 h (T
3
)
and tracheal extubation for 30 min (T
4
)
and chest CT one day after surgery and the occurrence of pulmonary complications within seven days after surgery were recorded.
Results
:
2
Compared with the conventional group
the oxygenation index at T
1
T
2
and T
3
and the lung dynamic compliance in the individualized group were significantly higher (
P
<
0.05) . At the same time
the airway platform pressure at T
1
T
2
and T
3
was significantly lower than that in the conventional group (
P
<
0.05) .
Conclusion
:
2
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.
关键词
最佳呼吸末正压肺顺应性氧合指数颅脑手术
Keywords
optimal positive end respiratory pressurelung complianceoxygenation indexcraniocerebral surgery
references
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Amato MBP, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome[J]. N Engl J Med, 2015, 372(8): 747-755.
Kangelaris KN, Calfee CS, May AK, et al. Is there still a role for the lung injury score in the era of the Berlin definition ARDS?[J]. Ann Intensive Care, 2014, 4(1): 4.
Futier E, Constantin JM, Pelosi P, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy[J]. Anesthesiology, 2010, 113(6): 1310-1319.
张才军, 谢俊然, 肖旺频, 等. 个体化保护性肺通气策略对老年患者全身麻醉肺通气效果的影响[J]. 中华实验外科杂志, 2019, 36(8): 1475-1478.
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