2025 年第 7 期 第 20 卷

肺保护性通气策略对高原地区行妇科开腹手术患者围手术期肺顺应性及氧合功能的影响

The effects of lung protective ventilation strategy on perioperative lung compliance and oxygenation function in patients undergoing gynecological open surgery in plateau area

作者：张培福熊成龙朵海珍俊琳王学军

英文作者：Zhang Peifu Xiong Chenglong Duo Haizhen Jun Lin Wang Xuejun

单位：青海红十字医院麻醉科，西宁810000

英文单位：Department of Anesthesiology Qinghai Red Cross Hospital Xining 810000 China

关键词：妇科开腹手术；肺保护性通气；高原地区；肺顺应性；氧合功能

英文关键词：Gynecologicalopensurgery;Lungprotectiveventilation;Plateauarea;Lungcompliance; Oxygenationfunction

• 摘要：

• 目的 探讨肺保护性通气策略对高原地区行妇科开腹手术患者围手术期肺顺应性及氧合功能的影响。方法 选取2023年12月至2024年12月在高原地区青海红十字医院行妇科开腹手术患者60例。根据随机数字表法分为常规通气组（C组）和肺保护性通气组（L组），每组30例。C组潮气量10 ml/kg，术中无呼气末正压和肺复张；L组潮气量6～8 ml/kg，呼气末正压为5 cmH2O（1 cmH2O=0.098 kPa），每30分钟进行1次肺复张。比较2组患者麻醉诱导插管后5 min（T1）、机械通气后1 h（T2）和手术完成拔管前（T3）3个时点的气道峰压、平均气道压、肺顺应性、生命体征。并在这3个时点抽取动脉血进行血气分析，比较动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、肺泡-动脉氧分压差（PA-aDO2）、氧合指数及无效腔与潮气量比值。结果 L组T2、T3时点呼气末二氧化碳分压明显高于C组（均P＜0.05）。L组T2、T3时点气道峰压、平均气道压明显低于C组，肺顺应性明显高于C组［（56±16）L/cmH2O比（47±9）L/cmH2O、（56±16）L/cmH2O比（46±9）L/cmH2O］（均P＜0.05）。与T1时点比较，2组T2、T3时点PaO2、氧合指数明显下降，PA-aDO2、无效腔与潮气量比值明显升高，C组T2、T3时点PaCO2明显下降，L组T2、T3时点PaCO2明显升高（均P＜0.05）。L组T2、T3时点PaO2、PaCO2、氧合指数明显高于C组，PA-aDO2明显低于C组（均P＜0.05）。结论 肺保护性通气策略能显著改善高原地区妇科开腹手术患者围手术期的肺顺应性和氧合功能，降低术后肺部并发症的发生率。

• Objective  To investigate the effects of lung protective ventilation strategy on perioperative lung compliance and oxygenation function in patients undergoing gynecological open surgery in plateau area. Methods Sixty patients who underwent gynecological open surgery in Qinghai Red Cross Hospital in the plateau region from December 2023 to December 2024 were selected.According to the random number table method, they were divided into conventional ventilation group (group C) and lung protective ventilation group (group L), with 30 cases in each group. In group C, the tidal volume was 10 ml/kg, and there was no positive end-expiratory pressure and lung recruitment maneuverduring the operation. In group L, the tidal volume was 6-8 ml/kg, positive end-expiratory pressure was 5 cmH2O, and lung recruitment maneuvers were performed every 30 minutes. The peak airway pressure, mean airway pressure, lung compliance and vital signs were compared between the two groups at 5 min after anesthesia induction intubation (T1), 1 h after mechanical ventilation (T2) and before surgical extubation (T3). Arterial blood samples were collected at each time point for blood gas analysis. Arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), alveolo-arterial partial pressure of oxygen (PA-aDO2), oxygenation index and the ratio of dead space to tidal volume were compared. Results The levels of the end-tidal carbon dioxide partial pressure at T2 and T3 in group L were significantly higher than those in group C (both P<0.05). The peak airway pressure and mean airway pressure at T2 and T3 in group L were significantly lower than those in group C, and the lung compliance was significantly higher than that in group C ［(56±16)L/cmH2O vs (47±9)L/cmH2O, (56±16)L/cmH2O vs (46±9)L/cmH2O］(all P<0.05). Compared with T1, PaO2 and oxygenation index at T2 and T3 were significantly decreased in the two groups, PA-aDO2 and the ratio of ineffective cavity to tidal volume increased significantly, PaCO2 decreased significantly at T2 and T3 in group C, and PaCO2 increased significantly at T2 and T3 in group L (all P<0.05). PaO2, PaCO2 and oxygenation index at T2 and T3 in group L were significantly higher than those in group C, while PA-aDO2 was significantly lower than that in group C (all P<0.05). Conclusion Lung protective ventilation strategy can significantly improve perioperative lung compliance and oxygenation function in patients undergoing gynecological open surgery in plateau area, and reduce the incidence of postoperative pulmonary complications.