保护性机械通气对气管插管全麻骨科手术患者术中生命体征指标和肺功能影响.docVIP

保护性机械通气对气管插管全麻骨科手术患者术中生命体征指标和肺功能的影响 　　[摘要] 目的 探?保护性机械通气在气管插管全麻骨科手术中的应用，并观察患者生命体征、肺功能变化情况。 方法 纳入我院收治的气管插管全麻骨科患者70例，按照数字随机表分成常规MV组、保护性MV组各35例，比较两组生命体征（PaO2、PaCO2、体温）、血流动力学（HB、MAP、HR）、炎症细胞因子（IL-6、TNF-α）、肺表面活性蛋白-A（SP-A）、肺部功能（FVC、FEV1、FEV1/FVC）及肺部并发症率。 结果 ①保护性MV组T3、T4时段的PaCO2较常规MV组更高，T1、T2、T3、T4时段的PaO2也高于常规MV组（P0.05）；②保护性MV组T1、T2时段MAP、Hb、HR较常规MV组更高，T1及T4时段SP-A、TNF-α、IL-6与各肺功能指标高于常规MV组，组间比较差异有统计学意义（P0.05）；③保护性MV组并发症发生率为5.71%，低于常规MV组的22.86%，两组对比差异有统计学意义（P0.05）。 结论 与常规通气相比，保护性机械通气有利于降低血流动力学指标与PaCO2、PaO2下降幅度，促进术后肺功能改善，控制肺部并发症风险，值得临床推广。 　　[关键词] 保护性机械通气；全麻；骨科手术；肺功能 　　[中图分类号] R614.2 [文献标识码] B [文章编号] 1673-9701（2017）30-0108-04 　　[Abstract] Objective To explore the application of protective mechanical ventilation in orthopedic surgery under tracheal intubation general anesthesia and observe the changes of vital signs and pulmonary function. Methods 70 cases of patients with orthopedic surgery under tracheal intubation general anesthesia were selected for the study and divided into the conventional MV group and the protective MV group with 35 cases in each group according to the random number table method. The vital signs（PaO2， PaCO2， temperature）， hemodynamics（HB， MAP， HR）， inflammatory cytokines （IL-6， TNF-α）， pulmonary surfactant protein-A （SP-A）， pulmonary function （FVC， FEV1， FEV1/FVC） and the incidence rate of pulmonary complications were compared between the two groups. Results ①The levels of PaCO2 at T3 and T4 time periods in the protective MV group were higher than those in the conventional MV group， and the levels of PaO2 at T1， T2， T3 and T4 time periods were also higher than those in the conventional MV group（P0.05）. ②The levels of MAP， Hb and HR at the T1 and T2 time periods in the protective MV group were higher than those in conventional MV group. The levels of SP-A， TNF-α， IL-6 and lung function indexes at T1 and T4 time periods were higher than those in the conventional MV group（P0.05）. ③The complication rate was 5.71% in the protective MV group， which was low