Batyrkhanov Mukhtar, Mukhtarkhanova Dilyara
Department of Surgery with Courses In Reanimatology and Anesthesiology Kazakh-Russian Medical University.
Department of Cardiology Asfendiyarov Kazakh National Medical University.
Can J Respir Ther. 2025 May 13;61:117-127. doi: 10.29390/001c.137289. eCollection 2025.
Adequate respiratory support with mechanical lung ventilation (MLV) is crucial for maintaining gas exchange and pulmonary circulation hemodynamics in patients with severe lung diseases in the perioperative period. However, the selection of optimal parameters for ventilation is often a serious problem, which can lead to the development of complications and worsening of treatment outcomes.
This study aimed to evaluate the effectiveness of the developed method of individual calculation of ventilator parameters to optimize respiratory support in patients with various lung diseases undergoing surgical intervention.
This study used a prospective clinical approach to optimize mechanical lung ventilation by calculating individualized ventilatory parameters based on each patient's lung function during surgery.
The results showed that in patients with unilateral lesions, the application of the developed method achieved PaO2 94.1±6.7 mmHg and PaCO2 36.2±4.5 mmHg, mean pulmonary artery pressure 25.8±3.6 mmHg, as well as cardiac output 4.8±0.8 l/min and oxygen transport 489±77 ml/min at the final post-operative stage. Even in bilateral diffuse lesions, individualized ventilatory parameters provided PaO2 79.6±11.3 mmHg and reduced bronchial resistance to 11.4±3.6 cmH2O/l/sec after surgery. Despite gross respiratory dysfunction, the personalized approach maintained PaO2 79.2±9.7 mmHg and PaCO2 46.1±6.3 mmHg postoperatively in patients with congenital pulmonary malformations such as cystic hypoplasia.
This study demonstrates the high efficacy of personalized approaches to respiratory support management to improve patient outcomes and reduce the risk of complications in patients with lung disease in the perioperative period.
在围手术期，对于患有严重肺部疾病的患者，通过机械肺通气（MLV）提供足够的呼吸支持对于维持气体交换和肺循环血流动力学至关重要。然而，选择最佳通气参数往往是一个严重问题，这可能导致并发症的发生和治疗效果的恶化。
本研究旨在评估所开发的呼吸机参数个体化计算方法在优化接受手术干预的各种肺部疾病患者呼吸支持方面的有效性。
本研究采用前瞻性临床方法，通过在手术期间根据每位患者的肺功能计算个体化通气参数来优化机械肺通气。
结果显示，在单侧病变患者中，应用所开发的方法在术后最终阶段实现了动脉血氧分压（PaO2）为94.1±6.7 mmHg、动脉血二氧化碳分压（PaCO2）为36.2±4.5 mmHg、平均肺动脉压为25.8±3.6 mmHg，以及心输出量为4.8±0.8 l/min和氧输送量为489±77 ml/min。即使在双侧弥漫性病变中，个体化通气参数在术后也使PaO2达到79.6±11.3 mmHg，并将支气管阻力降低至11.4±3.6 cmH2O/l/sec。对于先天性肺发育不良等先天性肺部畸形患者，尽管存在严重的呼吸功能障碍，但个性化方法在术后仍维持了PaO2为79.2±9.7 mmHg和PaCO2为46.1±6.3 mmHg。
本研究证明了个性化呼吸支持管理方法在改善围手术期肺部疾病患者的治疗效果和降低并发症风险方面具有很高的疗效。
