麻醉苏醒期应用压力支持通气模式对腹腔镜下胃癌根治术患者术后肺不张的影响

Effect of Pressure Support Ventilation during Emergence from Anesthesia on Postoperative Atelectasis in Patients Undergoing Laparoscopic Radical Gastrectomy

摘要: 目的：探讨麻醉苏醒期使用压力支持通气模式(PSV)相较于传统手控模式对腹腔镜下胃癌根治术患者术后肺不张的影响。方法：选择择期全麻下腹腔镜胃癌根治术患者70例，年龄 ≥ 18岁，ASA II或III级，手术时间 ≥ 2 h。采用随机数字表法将患者分为两组：PSV组(P组)和对照组(C组)。麻醉苏醒期，P组采用PSV通气模式，C组采用传统手控通气模式。采用床旁超声评估12个区域(左肺和右肺各6个区域)的肺超声(LUS)评分。记录麻醉诱导前(T₀)、拔管后30 min (T₃)的LUS评分和肺不张的发生情况。记录T₀、进入AICU时(T₂)、T₃的SpO₂、PaO₂及氧合指数(OI)。记录拔除气管导管前(T₁)的呼气末二氧化碳(P_ETCO₂)、气道峰压(P_peak)、平台压(P_plat)、潮气量V_TPBW。结果：与C组比较，P组T₃时LUS评分及肺不张发生率明显降低(P < 0.05)，T₁时V_TPBW明显升高(P < 0.05)，T₁时P_peak、P_plat明显降低(P < 0.05)，T₂、T₃时SpO₂、PaO₂、OI明显升高(P < 0.05)。结论：与传统手控通气模式比较，麻醉苏醒期使用PSV通气模式可以明显改善腹腔镜胃癌根治术患者术后30 min的氧合功能，减少术后肺不张的发生。

Abstract: Objective: To explore the effect of the pressure support ventilation mode (PSV) during the anesthesia recovery period compared with the traditional manual control mode on postoperative atelectasis in patients undergoing laparoscopic radical gastrectomy. Methods: Seventy patients undergoing laparoscopic radical gastrectomy under elective general anesthesia, aged ≥ 18 years, with American Society of Anesthesiologists (ASA) physical status II or III, and with a surgical duration of ≥ 2 hours were selected. The random number table method was used to divide the patients into two groups: the PSV group (group P) and the control group (group C). During the anesthesia recovery period, the PSV ventilation mode was used in group P, and the traditional manual ventilation mode was used in group C. Bedside ultrasound was used to evaluate the lung ultrasound (LUS) score of 12 regions (6 regions in the left lung and 6 regions in the right lung). The LUS scores and the occurrence of atelectasis before anesthesia induction (T₀) and 30 minutes after extubation (T₃) were recorded. The SpO₂, PaO₂ and oxygenation index (OI) at T₀, when entering the Acute Intensive Care Unit (AICU) (T₂), and at T₃ were recorded. The end-tidal carbon dioxide (P_ETCO₂), peak airway pressure (P_peak), plateau pressure (P_plat), and tidal volume per predicted body weight (V_TPBW) before tracheal extubation (T₁) were recorded. Results: Compared with group C, the LUS score and the incidence of atelectasis at T₃ in group P were significantly decreased (P < 0.05), the V_TPBW at T₁ was significantly increased (P < 0.05), while the P_peak, and P_plat at T₁ were significantly decreased (P < 0.05). The SpO₂, PaO₂, and OI at T₂ and T₃ were significantly increased (P < 0.05). Conclusion: Compared with the traditional manual ventilation mode, using the PSV ventilation mode during the anesthesia recovery period can significantly improve the oxygenation function 30 minutes after surgery of patients undergoing laparoscopic radical gastrectomy, and reduce the occurrence of postoperative atelectasis.