文章摘要
老年患者脊柱手术中肺保护性通气策略对呼吸参数的影响
Effect of lung protective ventilation strategy in elderly patients undergoing spinal operation in the prone position
  
DOI：10.12089/jca.2021.07.011
中文关键词: 老年  俯卧位  肺保护性通气策略  肺功能
英文关键词: Aged  Prone position  Lung protective ventilation strategy  Pulmonary function
基金项目:首都特色临床应用研究（Z161100000516135）
作者单位E-mail
陈莹 100730,国家老年医学中心,中国医学科学院老年医学研究院,北京医院麻醉科  
曲宗阳 100730,国家老年医学中心,中国医学科学院老年医学研究院,北京医院麻醉科  
包杰 100730,国家老年医学中心,中国医学科学院老年医学研究院,北京医院麻醉科  
李伟 100730,国家老年医学中心,中国医学科学院老年医学研究院,北京医院麻醉科  
左明章 100730,国家老年医学中心,中国医学科学院老年医学研究院,北京医院麻醉科 zuomz@163.com 
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中文摘要:
      
目的 探讨肺保护性通气与传统通气策略对老年患者俯卧位脊柱手术中呼吸参数的影响。
方法 选择2016年6月至2019年1月择期行俯卧位脊柱手术的老年患者98例，男36例，女62例，年龄≥65岁，ASA Ⅰ—Ⅲ级，在全麻下行脊柱手术（手术时间≥2 h）。根据术中通气方式将患者随机分为两组：肺保护通气组（P组）和传统通气组（C组）。P组采用小潮气量、中等呼气末正压和周期性肺复张；C组采用传统潮气量、不常规使用呼气末正压和肺复张。记录俯卧位后5 min、1、2、3、4、5 h气道峰压（Ppeak）、气道平台压（Pplat）、驱动压力和肺顺应性。记录俯卧位后和手术结束前pH值、PaO2/FiO2、PaCO2、PETCO2和碱剩余（BE）。记录术后肺部并发症发生情况。
结果 与C组比较，俯卧位后5 min、1、2、3、4 h P组的Ppeak、Pplat、驱动压力明显降低（P<0.05），俯卧位后和手术结束前P组 pH明显降低，PETCO2、PaCO2明显升高（P＜0.05）。两组PaO2/FiO2、BE和术后肺部并发症发生率差异无统计学意义。
结论 在俯卧位脊柱手术中，肺保护性通气策略气道压力更低，但可能存在通气不足的风险。
英文摘要:
      
Objective To explore the effect of the lung protective ventilation strategy and traditional ventilation on respiratory parameters in elderly patients undergoing prone spine surgery.
Methods A total of 98 patients who underwent spinal operation in the prone position from June 2016 to January 2019 were collected, including 36 males and 62 females, aged ≥65 years, operation time ≥ 2 h, with ASA physical status Ⅰ-Ⅲ, were divided into two groups: lung protective ventilation group (group P) and traditional ventilation strategy group (group C). Group P was ventilated with low tidal volume, medium positive end-expiratory pressure and regular lung recruitment maneuver. In group C, the ventilation protocol was traditional tidal volume, without positive end-expiratory pressure and regular lung recruitment maneuver. The peak pressure (Ppeak), plateau pressure (Pplat), driving pressure and lung compliance 5 minutes, 1 hour, 2, 3, 4 and 5 hours after the prone position were recorded. The pH, PaO2/FiO2, PaCO2, PETCO2, and base excess (BE) were recorded after the prone position and before operation completed. The postoperative pulmonary complications were recorded.
Results Compared with group C, the Ppeak, Pplat, and driving pressure were significantly decreased 5 min, 1 hour, 2, 3, 4 hours after the prone position in group P (P<0.05), while PETCO2 and PaCO2 were significantly increased and pH decreased after the prone pesition and before operation completed in group P (P < 0.05). There were no significant differences in PaCO2/FiO2, BE and postoperative pulmonary complications between the two groups.
Conclusion Pulmonary protective ventilation strategy has lower airway pressure than traditional ventilation but may be at risk of inadequate ventilation in elderly patients undergoing spinal operation in the prone position.
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