目的:了解小潮气量下进行肺部的保护性通气应用于老年人群中肺功能不全的胃肠手术患者的效果,分析该方法相比传统机械通气的差异,为该类患者人群麻醉过程中通气方式的选择提供指导.方法:2012年2月至2016年12月期间,对我院收治的140例胃肠手术患者,采用随机数字表随机分为对照组(传统机械通气组)和实验组(保护性通气管理组),每组均为70例患者,比较两组患者手术前后(T0~T4)手术相关指标(Pplat、Ppeak、PErCO2、Raw、麻醉时间、手术时间、手术出血量、输液量、尿量);气道监测指标(P 峰、P 平均、CL);血氧饱和度及相关指标(PaO2、PaCO2、OI、Qs/Qt);炎症因子及相关指标(IL-6、IL-8、TNF-α、CC16、SP-D、sRAGE)的统计学差异.结果:两组患者 Pplat、PErCO2、Raw、麻醉时间、手术时间、手术出血量指标的差异具有统计学意义(P<0.05),实验组 Pplat、PErCO2、Raw大于对照组,麻醉时间、手术时间、手术出血量小于对照组;实验组和对照组不同时点P 峰、P 平均、CL指标的差异具有统计学意义(P<0.05),两组比较P 峰(T1、T2、T3)、P 平均(T2、T3)、CL(T2、T3、T4)指标的差异具有统计学意义(P<0.05),实验组不同时点各项指标总体小于对照组;实验组和对照组不同时点PaO2、PaCO2、OI、Qs/Qt指标的差异具有统计学意义(P<0.05),两组比较 PaO2(T2、T3、T4)、PaCO2 (T1、T2、T3、T4)、Qs/Qt(T1、T2、T3、T4)指标的差异具有统计学意义(P<0.05),对照组不同时点 PaO2、PaCO2、OI、Qs/Qt均小于实验组;实验组和对照组不同时点 IL-6、IL-8、TNF-α、CC16、SP-D、sRAGE 指标的差异具有统计学意(P<0.05),两组比较IL-6(T1、T2)、TNF-α(T1、T2、T3、T4)、CC16(T1、T2、T3)、SP-D(T1、T2、T3)、sRAGE(T1、T2、T3、T4)指标的差异具有统计学意义(P<0.05),对照组不同时点 TNF-α、CC16、SP-D总体高于实验组,而sRAGE 均小于实验组.结论:存在肺功能不全的胃肠手术老年患者,进行小潮气量的肺部保护性通气,相比传统的机械通气能减轻患者炎症程度,更好的保障患者气道功能、血气状况及麻醉安全性.%Objective:To provide guidance for the patients with anesthesia ventilation in the selection process by understanding of gastrointestinal surgery used in lung protective ventilation with low tidal volume to the elderly pulmonary insufficiency results and analysis of the method of difference between the traditional me-chanical ventilation. Methods:From February 2012 to December 2016,140 cases of gastrointestinal surgery admitted in our hospital were randomly divided into control group (traditional mechanical ventilation group) and experimental group(protective ventilation management group),with 70 patients in each group. The oper-ation related indicators (Pplat, Ppeak, PErCO2, Raw, anesthesia time, operative time, operative bleeding volume,transfusion volume and urine volume) of the two groups before and after operation (T0-T4) were compared. The statistical difference of airway monitoring index, oxygen saturation and related indicators (PaO2,PaCO2,OI,Qs/Qt),inflammatory cytokines and related indicators (IL-6,IL-8,TNF-α, CC16, SP-D,sRAGE) of two groups were compared. Results:The differences of Pplat,PErCO2,Raw,time of an-esthesia,operation time and bleeding volume of the two groups were statistically significant (P<0.05). The Pplat,PErCO2and Raw in the experimental group were larger than those in the control group,and the time of anesthesia,the operation time and the amount of bleeding were less than those of the control group. The differ-ence of P peak,P average and CL index in the experimental group and the control group was statistically sig-nificant (P<0.05). The difference of P peak(T1,T2,T3),P average(T2,T3),CL(T2,T3,T4) between the two groups were statistically significant (P<0.05). The overall index of the experimental group was less than that of the control group. The differences of PaO2,PaCO2,OI and Qs/Qt in the experimental group and the control group were statistically significant (P<0.05). The differences of PaO2(T2, T3, T4), PaCO2(T1, T2,T3,T4) and Qs/Qt between the two groups were statistically significant. The PaO2,PaCO2,OI and Qs/Qt in the control group were less than those in the experimental group. The differences of IL-6,IL-8,TNF-alpha,CC16,SP-D and sRAGE in the experimental group and the control group were statistically significant (P<0.05). The difference of IL-6(T1,T2),TNF-alpha(T1,T2,T3,T4),CC16(T1,T2,T3),and the index of between the two groups were statistically significant. The TNF-alpha,CC16 and SP-D in the control group were higher than those in the experimental group,but the sRAGE was less than the experimental group. Conclusions:Gastrointestinal surgery in elderly patients with pulmonary insufficiency,lung protective ventila-tion of low tidal volume,compared to conventional mechanical ventilation can reduce the severity of inflamma-tion,better protect the airway function and blood gas status and safety of anesthesia.
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