| 温福腾,董师武,施沃维,等.肺保护性通气策略在创伤性颅脑损伤 45例围术期中的应用[J].安徽医药,2021,25(3):504-508. |
| 肺保护性通气策略在创伤性颅脑损伤 45例围术期中的应用 |
| Application of lung protective ventilation strategy in perioperative period of 45 patients with traumatic brain injury |
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| DOI：10.3969/j.issn.1009-6469.2021.03.018 |
| 中文关键词: 颅脑损伤 呼吸，人工 肺保护性通气策略 围手术期 氧合功能 颅内压 脑灌注压 |
| 英文关键词: Craniocerebral trauma Respiration, artificial Lung protective ventilation strategy Perioperative period Oxygen? ation function Intracranial pressure Cerebral perfusion pressure |
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| 中文摘要: |
| 目的探讨肺保护性通气策略在创伤性颅脑损伤围术期呼吸管理机械通气中的作用。方法选择 2018年 6月至 2019年 6月鹤山市人民医院创伤性中、重型颅脑损伤行颅骨开窗减压颅内血肿清除手术病人 90例，按随机数字表法分为常规容量控制通气组( CV组)和肺保护性通气策略组( PV组)每组 45例。两组均采用气管插管全麻机械通气，呼吸参数设置: CV组:潮气量 10 mL/kg，呼吸频率 10~12次/分，吸呼比 1∶2，吸入，氧浓度( FiO2)60%，氧流量 1~2 L/min；PV组潮气量 6~8 mL/kg，呼吸频率 10~15次/分，吸呼比 1∶2，呼气末正压( PEEP)5 cmH2o，FiO260%，氧流量 1~2 L/min，每隔 6h予手法肺复张 3次。记录麻醉诱导前( T0)、机械通气开始( T1)、首次颅内压( ICP)监测时( T2)、术毕关颅( T3)、术后 12 h(T4)、术后 24 h(T5)、术后 48 h(T6)、术后 72 h(T7)、术后 5d(T8)的平均动脉压( MAP)、脉搏血氧饱和度( SPO2)、呼气末二氧化碳分压( PETCO2)，T2~T8时 ICP，计算脑灌注压( CPP)；记录各时段动脉氧分压( PaO2)、动脉二氧化碳分压( PaCO2)变化，计算肺氧合指数( OI)、肺泡 -动脉血氧分压差(PA-aDO2)的数值；观察记录手术时间、失血量、机械通气时间、术后肺部并发症及术后脑梗死的情况。结果与 CV组比较， PV组 T6~T8时 SPO2升高( P<0.05)，T1~T5时 PETCO2显著升高( P<0.05)T3~T8时 PaO2显著升高( P<0.05)，T1~T4时 PaCO2较高( P<0.05)，T6~T8时 PaCO2下降， T3~T8时 OI显著增大( P<0.05)T2~T8PA-aDO2降低( P<0.05)机械通气时间缩短［(9.1±2.5)d比时，(13.0±4.2)d］、术后肺部并发症及术后脑梗死［4.5%(2/45)7.8%(8/45)］显著较少( P<0.05。两组病人 MAP、ICP、CPP、手术时间、失血量，均差异无统计学意义( P>0.05)。结论肺保护性通气策略具有预防肺不张、肺损伤，改善肺氧合功能，减少术后比1，)，肺部并发症发生，是创伤性颅脑损伤围术期呼吸管理机械通气的理想方法。 |
| 英文摘要: |
| Objective To probe into the role of lung protective ventilation strategy in perioperative mechanical ventilation of traumat? ic brain injury.Methods From June 2018 to June 2019, ninety patients of Heshan People′s Hospital with moderate to severe traumat?ic brain injury who received craniotomy and intracranial hematoma removal were selected, and the patients were randomly divided intotwo groups: routine volume control ventilation group (group CV) and lung protective ventilation strategy group (group PV), with 45 casesin each group. Patients in both groups were under general anesthesia and mechanical ventilated by tracheal intubation. The respirationparameters were set as follows: In group CV:VT10 mL/kg, RR10-12 times/min, I∶E1∶2, FiO260%, oxygen flow 1-2 L/min; In group PV:VT6-8 mL/kg, RR10-15 times/min, I∶E1∶2, PEEP 5cmH2O, FiO260%, oxygen flow 1-2 L/min, and lung recruitment maneuvers (LRM) were implemented 3 times every 6 hours. The MAP, SpO2 and PETCO2 were recorded at the following point in time: before anes?thesia induction (T0), at the beginning of mechanical ventilation (T1), at the first ICP monitoring (T2), after craniotomy (T3),12 hours af?ter operation (T4),24 hours after operation (T5),48 hours after operation (T6),72 hours after operation (T7) and 5 days after operation(T8). ICP at T2-T8 and CPP were calculated. The PaO2 and PaCO2 were recorded in each period, the changes of OI and PA-aDO2 were calculated, The operation time, blood loss, mechanical ventilation time, postoperative pulmonary complications and cerebral infarctionwere also recorded.Results Compared with group CV, SpO2 at T6-T8, PETCO2 at T1-T5, PaO2 at T3-T8, PaCO2 at T1-T4 and OI at T3T8 in group PV were significantly increased (P<0.05). Also compared with group CV, PaCO2 at T6-T8 and PA-aDO2 at T2-T8 in group PV were significantly decreased (P<0.05). At last, the duration of mechanical ventilation [(9.1±2.5)d vs. (13.0±4.2)d], incidence of post? operative pulmonary complications and postoperative cerebral infarction [4.5%(2/45) vs. 17.8%(8/45)] were both significantly decreased (P<0.05) in group PV compared with group CV. There was no significant difference in MAP, ICP, CPP, operation time and blood lossbetween both groups (P>0.05).Conclusions The lung protective ventilation strategy can prevent atelectasis and lung injury, improvelung oxygenation function and reduce postoperative pulmonary complications. It is an ideal method for the management of mechanical ventilation in the perioperative period of traumatic brain injury. |
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