Ding Yinyin, Huang Tianfeng, Gao Ju, Zhu Xiangpeng, Ge Yali, Zhang Yang
Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou Clinical Medical College of Xuzhou Medical University, 98 Nan Tong Western Road, Yangzhou, Jiangsu Province, 225001, China.
BMC Surg. 2025 Aug 6;25(1):346. doi: 10.1186/s12893-025-03115-0.
This study aimed to investigate the potential effects of intraoperative open-lung strategy (OLS) on pulmonary function and cardiac function in elderly frail patients.
104 frail elderly patients were randomly assigned into non-OLS group [small tidal volume (VT) + 5 cm H2O positive end-expiratory pressure (PEEP)] and OLS group [small VT + stepwise recruitment maneuvers (RM) + individualized PEEP]. Primary outcomes assessed were intraoperative cardiopulmonary function indices and incidence of postoperative pulmonary complications. Secondary outcomes included postoperative myocardial injury markers and recovery outcomes.
Eighty-one patients completed the final analysis. The OLS group showed significant improvements in arterial oxygen pressure (PaO), PaO₂/FiO₂ ratio, and pulmonary dynamic compliance (Cdyn) from the peak of lung recruitment to the end of surgery (T-T). The overall incidence of postoperative pulmonary complications (PPCs) also significantly decreased (<0.05). Compared with the non-OLS group, left ventricular ejection fraction (LVEF), stroke volume (SV), early mitral inflow velocity to early mitral annular velocity ratio (E/E ‘), left ventricular global longitudinal strain (LVGLS), and plane systolic offset of mitral and tricuspid annular plane were significantly decreased at T1 in the OLS group (<0.05), and recovered at T3. No significant change in the expression of myocardial injury markers between the two groups ( > 0.05). The postoperative recovery outcomes of OLS patients was significantly shortened (<0.05).
The application of OLS can effectively improve intraoperative respiratory mechanics and oxygenation in frail elderly patients, reduce the occurrence of PPCs, and shorten hospital stays of patients, without continuous negative impact on cardiac function.
Retrospectively registered; Chinese Clinical Trial Registry, www.chictr.org.cn, number: ChiCTR2200058783; Registered on April 17, 2022.
The online version contains supplementary material available at 10.1186/s12893-025-03115-0.
本研究旨在探讨术中开放肺策略（OLS）对老年体弱患者肺功能和心功能的潜在影响。
104例体弱老年患者被随机分为非OLS组[小潮气量（VT）+5cmH₂O呼气末正压（PEEP）]和OLS组[小VT+逐步肺复张手法（RM）+个体化PEEP]。评估的主要结局是术中心肺功能指标和术后肺部并发症的发生率。次要结局包括术后心肌损伤标志物和恢复情况。
81例患者完成最终分析。OLS组从肺复张高峰到手术结束（T-T），动脉血氧分压（PaO）、PaO₂/FiO₂比值和肺动态顺应性（Cdyn）显著改善。术后肺部并发症（PPCs）的总体发生率也显著降低（<0.05）。与非OLS组相比，OLS组在T1时左心室射血分数（LVEF）、每搏输出量（SV）、二尖瓣早期流入速度与二尖瓣环早期速度比值（E/E‘）、左心室整体纵向应变（LVGLS）以及二尖瓣和三尖瓣环平面的平面收缩偏移显著降低（<0.05），并在T3时恢复。两组心肌损伤标志物表达无显著变化（>0.05）。OLS组患者的术后恢复时间显著缩短（<0.05）。
OLS的应用可有效改善老年体弱患者术中呼吸力学和氧合，减少PPCs的发生，缩短患者住院时间，且对心功能无持续负面影响。
回顾性注册；中国临床试验注册中心，www.chictr.org.cn，编号：ChiCTR2200058783；于2022年4月17日注册。
在线版本包含可在10.1186/s12893-025-03115-0获取的补充材料。
