Balonov Konstantin
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA.
Saudi J Anaesth. 2022 Jul-Sep;16(3):327-331. doi: 10.4103/sja.sja_386_22. Epub 2022 Jun 20.
Postoperative pulmonary complications (PPCs) occur frequently and are associated with a prolonged hospital stay, increased mortality, and high costs. Patients with morbid obesity are at higher risk of perioperative complications, in particular associated with those related to respiratory function. One of the most prominent concerns of the anesthesiologists while taking care of the patient with obesity in the perioperative setting should be the status of the lung and delivery of mechanical ventilation as its strategy affects clinical outcomes. Negative effects of mechanical ventilation on the respiratory system known as ventilator-induced lung injury include barotrauma, volutrauma, and atelectrauma. However, the optimal regimen of mechanical ventilation still remains a matter of debate. While low tidal volume (VT) strategy has become a widely accepted standard of care, the protective role of PEEP and recruitment maneuvers is less clear. This review focuses on the pathophysiology of respiratory function in patients with morbid obesity, the effects of mechanical ventilation on the lungs, and optimal intraoperative strategy based on the current state of knowledge.
术后肺部并发症（PPCs）频繁发生，与住院时间延长、死亡率增加及高成本相关。病态肥胖患者围手术期并发症风险更高，尤其是与呼吸功能相关的并发症。在围手术期照顾肥胖患者时，麻醉医生最关注的问题之一应是肺部状况及机械通气的实施，因为其策略会影响临床结局。机械通气对呼吸系统的负面影响即呼吸机诱导的肺损伤，包括气压伤、容积伤和肺不张伤。然而，机械通气的最佳方案仍存在争议。虽然低潮气量（VT）策略已成为广泛接受的标准治疗方法，但呼气末正压（PEEP）和肺复张手法的保护作用尚不清楚。本综述聚焦于病态肥胖患者呼吸功能的病理生理学、机械通气对肺部的影响以及基于当前知识水平的最佳术中策略。
