摘要目的 评价肺保护性通气对食管癌根治术病人的肺保护效应.方法 择期全麻下行食管癌根治术病人68例,性别不限,年龄40 ～ 64岁,ASA分级Ⅰ或Ⅱ级,体重指数17～40 kg/m2,采用随机数字表法分为2组(n=34):常规通气组(CV组)和保护性通气组(PV组).麻醉诱导后置入左侧双腔支气管导管,接麻醉机行机械通气.CV组双肺通气时VT10 ml/kg,单肺通气时VT7 ml/kg,吸呼比1∶2;PV组双肺通气时VT7 ml/kg,单肺通气时VT5 ml/kg,吸呼比1∶2,并给予PEEP 10 cmH2O,每45 min双肺行肺复张1次.分别于麻醉诱导前、术后第1天、第3天和第5天时行动脉血气分析,并记录临床改良肺部感染评分;分别于麻醉诱导前和术后第5天时行床旁肺功能检查,记录每分钟最大通气量占预计值的百分比(MVV％)、用力肺活量占预计值的百分比(FVC％)、第1秒用力呼气量占预计值的百分比(FEV1％),计算FEV1/FVC;记录术后5d内呼吸衰竭、肺不张、切口感染等的发生情况.结果 与CV组比较,PV组MVV％、FVC％、FEV1％和FEV1/FVC升高,术后各时点临床改良肺部感染评分降低,SaO2和PaO2升高(P＜0.05),肺不张和切口感染的发生率差异无统计学意义(P＞0.05).结论 肺保护性通气对食管癌根治术病人具有肺保护效应.

abstractsObjective To evaluate the protective effects of lung protective ventilation on the lungs in patients undergoing radical resection for esophageal cancer.Methods Sixty-eight patients of both sexes,aged 40-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index 17-40 kg/m2,scheduled for elective radical resection for esophageal cancer,were randomly divided into conventional ventilation group (CV group,n =34) and protective ventilation group (PV group,n =34) using a random number table.Double lumen tube was inserted after induction of anesthesia,an anesthesia machine was connected,and the patients were mechanically ventilated.In group CV,VT was set at 10 ml/kg during two-lung ventilation,and VT was set at 7 ml/kg,and I ∶ E was set at 1 ∶ 2 during one-lung ventilation.In group PV,VT was set at 7 ml/kg during two-lung ventilation,VT was set at 5 ml/kg,I ∶ E was set at 1 ∶ 2,and PEEP was set at 10 cmH2O during one-lung ventilation,and bilateral lung recruitment maneuver was performed every 45 min.Before induction of anesthesia,and at days 1,3,and 5 after surgery,blood gas analysis was performed,and Clinical Pulmonary Infection Score was recorded.Before induction of anesthesia,and at 5 days after surgery,point-of-care testing for pulmonary function was performed,and percentages of maximum ventilatory volume (MVV％),forced vital capacity (FVC％),and forced expiratory volume in 1 second (FEV1％) were recorded,and FEV1/FVC was calculated.The development of respiratory failure,pulmonary atelectasis and incision infection was recorded within 5 min after surgery.Results Compared with group CV,MVV％,FVC％,FEV1％ and FEV1/FVC were significantly increased,Clinical Pulmonary Infection Score was decreased at each time point after surgery,SaO2 and PaO2 were increased,and no significant changes were found in pulmonary atelectasis and incision infection in group PV.Conclusion Lung protective ventilation can effectively protect the lungs in the patients undergoing radical resection for esophageal cancer.