Objective To observe the effects of ventilation with low tidal volume and positive end-expiratory pressure (PEEP)in different periods on the postoperative pulmonary function and short-term prognosis in aged patients undergoing abdominal surgery.Methods Sixty aged patients undergoing selective open abdominal surgery scheduled for general anesthesia,21 males and 39 fe-males,were randomized into 3 groups (n =20).Patients in group A received PEEP 1 h after the be-ginning of surgery;patients in group B received PEEP 1 h before tracheal extubation;patients in group C received PEEP intraoperatively.The secretion score in preoperative,postoperative 24 h and 72 h respectively,and the arterial blood gas analysis indexes (PaCO 2 ,PaO 2 ,A-aDO 2 ,PaO 2/FiO 2 calculation)in postoperative 1 h and 24 h were recorded.Results Compared with preoperative,in postoperative 1 h,PaCO 2 increased obviously in all groups,PaO 2 decreased in group B,A-aDO 2 in-creased in group A (P <0.05);in postoperative 24 h,PaCO 2 was significantly increased in group B and C,PaO 2/FiO 2 decreased in group B (P <0.05).Compared with postoperative 1 h,in postopera-tive 24 h,PaCO 2 and A-aDO 2 decreased obviously in group A (P <0.05).There were no differences in postoperative secretions score in between the 3 groups.Conclusion Low tidal volume combined short-range PEEP in different periods of surgery may improve postoperative pulmonary oxygenation. But they had no obvious help with postoperative pulmonary complications.%目的 观察术中低潮气量联合不同阶段呼气末正压通气(positive end expiratory pres-sure,PEEP)对老年患者开腹术后肺功能及并发症的影响.方法 选择择期全麻下行开腹手术的老年患者60例,男21例,女39例,年龄≥65岁,ASAⅠ或Ⅱ级,随机分为三组,每组20例.A组手术开始后1 h联合PEEP 10 cm H 2 O持续1 h,B组术毕拔除气管导管前1 h联合PEEP 10 cm H 2 O持续1 h,C组手术全程联合PEEP 10 cm H 2 O.分别于术前、术后1、24 h行血气分析测PaCO 2、PaO 2和A-aDO 2,计算氧合指数.记录术前、术后24、72 h的气道分泌物评分.结果 与术前比较,术后1 h三组PaCO 2明显升高,B组PaO 2明显下降,A组A-aDO 2明显升高(P<0.05);术后24 h B组、C组PaCO 2明显升高,B组氧合指数明显下降(P<0.05).与术后1 h比较,术后24 h A组PaCO 2明显下降,A组A-aDO 2明显下降(P<0.05).术后三组气道分泌物评分差异无统计学意义.结论 术中低潮气量联合不同阶段PEEP能够改善术后肺的氧合功能,但对术后肺部并发症无明显影响.
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