南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (10): 1821-1826.doi: 10.12122/j.issn.1673-4254.2023.10.23

• • 上一篇    下一篇

驱动压指导的肺保护性通气策略对COVID-19感染康复期患者术后发生肺部并发症的影响

江连祥，陈文胜，余 伟，胡美珠，曹 亚，姚卫东，陈永权   

  1. 皖南医学院弋矶山医院麻醉科，安徽 芜湖 241000
  • 出版日期:2023-10-20 发布日期:2023-11-02

Driving pressure-guided lung protective ventilation strategy reduces postoperative pulmonary complications in patients recovered from COVID-19

JIANG Lianxiang, CHEN Wensheng, YU Wei, HU MeiZhu, CAO Ya, YAO Weidong, CHEN Yongquan   

  1. Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
  • Online:2023-10-20 Published:2023-11-02

RichHTML

11

PDF

273

摘要： 目的 探究驱动压指导的肺保护性通气策略（LPVS）预防新冠感染康复期患者术后肺部并发症（PPCs）的价值，为优化术中呼吸管理提供临床依据。方法 选择2022年12月~2023年2月经历新冠病毒感染，年龄≥18岁，ASA I~III级，择期在全身麻醉下行非心脏手术患者118例，采用计算机随机分为两组（每组59例）。LPVS组设VT为6 mL/kg，呼气末正压（PEEP）采用驱动压指导个体化滴定，每隔30 min进行1次肺复张；对照组采取常规机械通气。主要比较两组患者PPCs和低氧血症的发生风险，肺部超声评分等结局指标。结果 两组患者一般资料比较，差异无统计学意义（P>0.05）。LPVS组患者PPCs发生率（16.95% vs 35.59%，χ2=5.294，P=0.021）、低氧血症发生率（15.25% vs 30.51%，χ2=3.890，P=0.049）及肺部超声评分（5.31±1.07 vs 8.32±2.34，t=8.986，P<0.001）均低于对照组；LPVS组患者PEEP值、气道压及平台压高于对照组（P<0.05），驱动压和潮气量低于对照组（P<0.05）。结论 驱动压指导的肺保护性通气策略可改善新冠感染康复患者氧合，降低术后肺部并发症发生风险。

关键词: COVID-19；肺保护性通气；肺部并发症；气道驱动压

Abstract: Objective To investigate the value of lung protective ventilation strategy (LPVS) guided by driving pressure for preventing postoperative pulmonary complications (PPCs) in patients recovered from COVID-19 and optimize intraoperative respiratory management. Methods From December, 2022 to February, 2023, a total of 118 patients recovered from COVID-19 within a month (ASA I-III, aged ≥18 years) undergoing elective non-cardiac surgeries under general anesthesia in our hospital were randomized equally into LPVS group and control group. The patients in LPVS group received a tidal volume of 6 mL/kg with an individualized PEEP guided by minimum driving pressure and lung re- expansion every 30 min, and those in the control group received conventional mechanical ventilation. The incidence of PPCs and hypoxemia and pulmonary ultrasound score of the patients were compared between the two groups. Results There was no significant difference in the baseline data between LPVS group and the control group (P>0.05). Compared with the control group, LPVS group showed significantly lower incidences of PPCs (16.95% vs 35.59%, χ2=5.294, P=0.021) and hypoxemia (15.25% vs 30.51%, χ2=3.890, P=0.049) with also lower pulmonary ultrasound scores (5.31±1.07 vs 8.32±2.34, t=8.986, P<0.001). The PEEP value, airway pressure and plateau pressure in LPVS group were significantly higher, but the driving pressure and the tidal volume were lower than those in the control group (P<0.05). Conclusion LPVS guided by driving pressure can improve oxygenation and reduce the risk of PPCs in patients recently recovered from COVID-19.

Key words: COVID-19; lung protective ventilation; postoperative pulmonary complications; driving pressure