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| 肺超声评分评价肺保护性通气策略对老年开腹手术患者肺损伤的影响 |
| Effect of protective lung ventilation strategy on pulmonary injury in elderly patients undergoing open abdominal surgery as assessed by lung ultrasound score |
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| DOI：10.12089/jca.2021.09.001 |
| 中文关键词: 肺超声 肺保护性通气策略 老年患者 开腹手术 肺损伤 |
| 英文关键词: Pulmonary ultrasound Protective lung ventilation strategy Aged Open abdominal surgery Pulmonary injury |
| 基金项目:南京市医学科技发展资金资助(QRX17019，YKK18105)；江苏省六大人才高峰项目(WSW-106) |
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| 中文摘要: |
目的 通过肺超声评分探讨肺保护性通气策略减轻老年开腹手术患者肺损伤的作用。
方法 选择2019年8月至2020年6月择期开腹手术患者50例，男33例，女17例，年龄65~80岁，BMI 18~25 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：对照组(C组)和肺保护性通气组(P组)，每组25例。所有患者常规麻醉诱导，采用容量控制的通气模式。C组设置VT 8 ml/kg，不使用呼气末正压(PEEP)；P组设置VT 6 ml/kg，PEEP 6 cmH2O，每间隔30 min给予手法肺复张。采用床旁超声评估患者双侧共12个区域的肺部超声，各区域分数累积为肺超声评分(LUS)。记录入室时(T0)、麻醉诱导气管插管后5 min(T1)、手术开始后2 h(T2)、手术结束时(T3)、气管导管拔除后15 min(T4)、2 h(T5)、术后1 d(T6)的LUS评分、HR、MAP、SpO2、PaO2和PaCO2。记录T1—T3时的氧合指数(PaO2/FiO2)、气道峰压(Ppeak)、吸气末平台压(Pplat)和驱动压力(ΔP)。记录术后7 d内肺部并发症(PPCs)的发生情况。
结果 与T0时比较，T1—T5时C组和P组LUS评分明显升高(P<0.05)。与T1时比较，T2—T3时C组PaO2/FiO2明显降低(P<0.05)，P组ΔP明显降低(P<0.05)。与C组比较，P组T2—T5时LUS评分明显降低(P<0.05)，T2—T3时PaO2/FiO2明显升高(P<0.05)、ΔP明显降低(P<0.05)。C组术后7 d内PPCs发生率为20%，P组未发生PPCs(P<0.05)。
结论 床旁肺超声监测下，老年开腹手术患者在全麻期间和术后早期LUS评分升高，肺通气丢失。肺保护性通气策略可降低患者围术期的肺超声评分，减少肺通气损失，降低术后7 d的肺部并发症发生率。 |
| 英文摘要: |
Objective To investigate the effects of protective lung ventilation strategy on reducing pulmonary injury in elderly patients undergoing open abdominal surgery by detecting lung ultrasound score.
Methods Fifty patients from August 2019 to June 2020, recruited and scheduled to undergo elective open abdominal surgery, age 65-80 years, BMI 18-25 kg/m2, ASA physical stutas Ⅰ-Ⅲ, were randomly divided into two groups: control group (group C) and protective lung ventilation group (group P), 25 patients in each group. After induction of general anesthesia, all patients received volumetric ventilation. Patients in group C were received VT 8 ml/kg without positive end-expiratory pressure (PEEP). Patients in group P received VT 6 ml/kg, PEEP 6 cmH2O, and pulmonary volume recruitment manoeuvres (RM) every 30 minutes. Lung ultrasonography was undertaken to evaluate the score of lung ultrasound at 12 regions of bilateral lung. The score of each region was accumulated as lung ultrasound score (LUS). LUS were recorded when entering the operative room (T0), 5 minutes after tracheal intubation under general anesthesia (T1), 2 hours form surgery beginning (T2), at the end of surgery (T3), 15 minutes (T4) and 2 hours (T5) after tracheal catheter extraction, and 1 day after operation (T6). Oxygenation index (PaO2/FiO2), airway peak pressure (Ppeak), terminal inspiratory airway platform pressure (Pplat) and driving pressure (ΔP) were recorded at T1-T3. The occurrence of pulmonary complications (PPCs) were followed up 7 days after the surgery.
Results Compared with T0, LUS scores increased at T1-T5 in group C and P (P< 0.05). Compared with T1, PaO2/FiO2 decreased in group C, ΔP decreased in group P at T2 and T3 (P < 0.05). Compared with group C, LUS scores decreased at T2 and T3 in group P (P < 0.05), PaO2/FiO2 increased and ΔP decreased at T2 and T3 in group P (P < 0.05). The incidence of PPCs within 7 days after surgery was 20% in group C and 0% in group P (P < 0.05).
Conclusion For elderly patients undergoing open abdominal surgery, their LUS score increased and lung aeration losed assessed by lung ultrasound during general anesthesia and early postoperative period. Protective lung ventilation strategy with VT 6 ml/kg and PEEP/RM intraoperatively decreased LUS score reduced lung aeration loss during perioperation. |
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