CAJ | 학술논문

目的：探讨保护性通气策略应用于老年髋关节手术全身麻醉期间的临床有效性。方法选择择期老年全身麻醉下髋关节手术患者40例,随机分为：常规机械通气组( C组,20例)：潮气量( Vt)=9 mL/kg理想体重( IBW),初始呼吸频率( f)=12次/min,吸气呼气时间比( I∶E)=1∶2；保护性肺通气组( P组,20例)：Vt=7 mL/kg IBW,初始呼吸频率(f)=12次/min,I∶E=1∶2,呼气末正压设为6 cmH2O,每30分钟手法肺复张1次。术中吸入氧气浓度40%,调整呼吸频率维持PET CO235~45 mmHg。分别于麻醉诱导前( T1)、气管插管后5 min ( T2)、机械通气1．5 h( T3)、拔除气管导管后1 h( T4)、术后3 d( T5)观察记录HR、MAP、气道峰压( Ppeak)、气道平台压( Pmean),计算肺动态顺应性( Cdyn)；血气分析仪测定PaO2、PaCO2和Hb；观察术后肺部并发症。结果C组术后拔除气管导管后1 h和术后3 d,PaO2和氧合指数(PaO2/FiO2)均较术前降低(P<0．05),P组PaO2和氧合指数在拔除气管导管后1 h较术前降低( P<0．05),但术后3 d无明显差异,且在机械通气1．5 h、拔除气管导管后1 h和术后3 d均较C组显著增高( P<0．05)。 P组在机械通气期间 Ppeak和 Pmean均高于 C组( P<0．05)。两组在机械通气1．5 h后Cdyn降低(P<0．05),但P组高于C组(P<0．05)。 P组术后肺部并发症发生率明显低于C组(P<0．05)。结论肺保护策略能够有效提高老年髋关节手术患者肺顺应性,改善氧合,减少肺部并发症,利于呼吸功能恢复。
목적：탐토보호성통기책략응용우노년관관절수술전신마취기간적림상유효성。방법선택택기노년전신마취하관관절수술환자40례,수궤분위：상규궤계통기조( C조,20례)：조기량( Vt)=9 mL/kg이상체중( IBW),초시호흡빈솔( f)=12차/min,흡기호기시간비( I∶E)=1∶2；보호성폐통기조( P조,20례)：Vt=7 mL/kg IBW,초시호흡빈솔(f)=12차/min,I∶E=1∶2,호기말정압설위6 cmH2O,매30분종수법폐복장1차。술중흡입양기농도40%,조정호흡빈솔유지PET CO235~45 mmHg。분별우마취유도전( T1)、기관삽관후5 min ( T2)、궤계통기1．5 h( T3)、발제기관도관후1 h( T4)、술후3 d( T5)관찰기록HR、MAP、기도봉압( Ppeak)、기도평태압( Pmean),계산폐동태순응성( Cdyn)；혈기분석의측정PaO2、PaCO2화Hb；관찰술후폐부병발증。결과C조술후발제기관도관후1 h화술후3 d,PaO2화양합지수(PaO2/FiO2)균교술전강저(P<0．05),P조PaO2화양합지수재발제기관도관후1 h교술전강저( P<0．05),단술후3 d무명현차이,차재궤계통기1．5 h、발제기관도관후1 h화술후3 d균교C조현저증고( P<0．05)。 P조재궤계통기기간 Ppeak화 Pmean균고우 C조( P<0．05)。량조재궤계통기1．5 h후Cdyn강저(P<0．05),단P조고우C조(P<0．05)。 P조술후폐부병발증발생솔명현저우C조(P<0．05)。결론폐보호책략능구유효제고노년관관절수술환자폐순응성,개선양합,감소폐부병발증,리우호흡공능회복。
Objective To evaluate the clinical effectiveness of protective ventilation strategy in elderly hip op-eration during general anesthesia. Methods Forty elderly patients scheduled for hip operation under general anesthesia were randomly divided into 2 groups:conventional mechanical ventilation group(group C,n=20)and protective venti-lation group(group P,n=20). In group C,tidal volume(Vt) =9 mL/kg ideal body weight(IBW),initial respiration frequency(f) =12 bpm,inspiratory expiratory time ratio(I∶E) =1∶2. In group P,Vt=7 mL/kg IBW,initial respiration frequency(f) =12 bpm,I∶E=1∶2,positive end-expiratory pressure(PEEP) =6 cmH2O,and a manual lung recruitment was performed every thirty minutes. The concentration of oxygen inhalation was 40%and respiration frequency was ad-justed to maintain PETCO2 35 ~45 mmHg. The heart rate(HR),mean arterial pressure(MAP),peak airway pressure (Ppeak),plateau airway pressure(Pmean)were recorded and the lung dynamic compliance(Cdyn)was calculated be-fore induction of anesthesia( T1 ) ,5 min after intubation( T2 ) ,1. 5 h after mechanical ventilation( T3 ) ,1 h after extuba-tion( T4 ) ,3 d after operation( T5 ) . PaO2 ,PaCO2 and Hb were measured by gas analyzer at the above time points. The postoperative pulmonary complications were observed. Results In group C,PaO2 and oxygenation index( PaO2/FiO2 ) were decreased at 1 h after extubation and 3 d after operation compared with the preoperative data(P<0. 05). In group P,PaO2 and oxygenation index were decreased at 1 h after extubation compared with the preoperative data(P<0. 05), but no significant difference was found at 3 d after operation. Compared with group C, PaO2 and oxygenation index were increased at 1. 5 h after mechanical ventilation,1 h after extubation and 3 d after operation in group P(P<0. 05). Compared with group C,Ppeak and Pmean during mechanical ventilation were increased in group P(P<0. 05). Cdyn was decreased in the both groups,but Cdyn in group P was higher than that of group C(P<0. 05). Postoperative pul-monary complications were significantly lower than that of group C ( P <0. 05 ) . Conclusion Protective ventilation strategy can effectively improve the lung dynamic compliance and oxygenation,reduce pulmonary complications,pro-mote the recovery of respiratory function in elderly hip operation.