文章摘要
麻醉苏醒期PSVPro模式联合低吸入氧浓度对腹腔镜胃癌根治术后肺不张的影响
Effect of pressure support ventilation-pro combined with low inspiratory oxygen fraction during emergence from anesthesia on postoperative atelectasis in patients undergoing laparoscopic radical gastrectomy
  
DOI：10.12089/jca.2025.12.005
中文关键词: 吸入氧浓度  压力支持通气模式  麻醉苏醒期  肺超声  肺功能  肺不张
英文关键词: Fraction of inspiration oxygen  Pressure support ventilation  Emergence from anesthesia  Lung ultrasound  Lung function  Atelectasis
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作者单位E-mail
朱妍 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科(现在上海交通大学医学院附属新华医院重症医学科)  
鲜晓仝 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科  
王启兵 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科  
胡学涛 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科  
张野 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科  
李云 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科 yunli_001@aliyun.com 
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中文摘要:
      
目的：探讨在腹腔镜胃癌根治术患者麻醉苏醒期使用具备窒息保护的压力支持通气专业版（PSVPro）模式联合低吸入氧浓度（FiO2）对术后肺不张的影响。
方法：选择择期行全身麻醉下腹腔镜胃癌根治术患者70例，男39例，女31例，年龄≥18岁，BMI<40 kg/m2，ASA Ⅱ或Ⅲ级，手术时间≥2 h，术前加泰罗尼亚外科患者呼吸风险评估量表（ARISCAT）评分≥26分。采用随机数字表法将患者分为两组：PSVPro组（P组）和对照组（C组），每组35例。麻醉苏醒期，P组采用PSVPro通气模式联合FiO2 40%；C组采用传统手控通气模式联合FiO2 100%。采用床旁超声评估12个区域（左肺和右肺各6个区域）的肺超声（LUS）评分。记录麻醉诱导前、拔管后30 min的LUS评分和肺不张的发生情况。记录麻醉诱导前、入AICU时、拔管后30 min的SpO2、PaO2和氧合指数（OI）。记录拔管前即刻的气道峰压（Ppeak）、平台压（Pplat）、每公斤理想体重的潮气量（VT-PBW）。拔管时采用改良5点Likert量表测定咳嗽分级。记录术前1 d、术后1、3 d的FVC、FEV1，计算FEV1/FVC。
结果：与C组比较，P组拔管后30 min的LUS评分及肺不张发生率明显降低；拔管前即刻的Ppeak、Pplat与拔管时咳嗽分级明显降低，拔管前即刻的VT-PBW明显升高；入AICU时、拔管后30 min的SpO2、PaO2、OI明显升高；术后1 d FVC、FEV1、FEV1/FVC明显升高；术后3 d FEV1/FVC明显升高（P＜0.05）。
结论：与传统手控通气模式联合吸入纯氧比较，麻醉苏醒期采用PSVPro通气模式联合FiO2 40%可以明显改善腹腔镜胃癌根治术患者拔管后30 min的氧合功能与术后早期肺功能，减少术后肺不张的发生。
英文摘要:
      
Objective: To explore the effect of the professional version of pressure support ventilation mode with apnea protection (PSVPro) combined with low low inspiratory oxygen fraction (FiO2) during emergence from anesthesia on postoperative atelectasis in patients undergoing laparoscopic radical gastrectomy.
Methods: Seventy patients who were scheduled for elective laparoscopic radical gastrectomy under general anesthesia, 39 males and 31 females, aged ≥ 18 years, BMI < 40 kg/m2, ASA physical status Ⅱ or Ⅲ, operation time ≥ 2 hours, and preoperative assess respiratory risk in surgical patients in Catalonia (ARISCAT) score ≥ 26 points, were selected. The patients were randomly separated into two groups by the random number table method: PSVPro group (group P) and control group (group C), 35 patients in each group. During the anesthesia recovery period, group P was ventilated with the PSVPro mode combined with FiO2 40%, while group C was ventilated with the manual bag combined with FiO2 100%. Bedside ultrasound was used to assess the lung ultrasound (LUS) score of 12 regions (6 regions each in the left and right lungs). The LUS score and the occurrence of atelectasis were recorded before anesthesia induction and 30 minutes after extubation. SpO2, PaO2, and oxygenation index (OI) were recorded before anesthesia induction, entering into anesthesia intensive care unit (AICU), and 30 minutes after extubation. Ppeak, Pplat, and tidal volume per predicted body weight (VT-PBW) were recorded before tracheal extubation. The cough grade was measured using a modified 5-point Likert scale at the time of extubation. FVC, FEV1, and FEV1/FVC were recorded on the day before surgery and on postoperative days 1 and 3.
Results: Compared with group C, the LUS score and the incidence of atelectasis in group P 30 minutes after extubation were significantly decreased, the Ppeak and Pplat immediately before extubation and the cough grade at extubation were significantly decreased, the VT-PBW immediately before extubation was significantly increased, the SpO2, PaO2, and OI were significantly increased entering into AICU and 30 minutes after extubation, FVC, FEV1, and FEV1/FVC were significantly increased on postoperative day 1, and FEV1/FVC was significantly increased on postoperative day 3 (P < 0.05).
Conclusion: Compared with the conventional manual mode paired with pure oxygen, the PSVPro mode together with FiO2 40% during anesthesia recovery can notably enhance both the oxygenation function 30 minutes after extubation and the early postoperative lung function in patients who undergo laparoscopic radical gastrectomy for gastric cancer, while also lowering the rate of postoperative atelectasis.
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