阶梯式肺复张策略在老年患者中的临床应用及研究进展
Clinical Application and Research Progress of Stepwise Lung Recruitment Strategy in El-derly Patients

有报道指出，机械通气会大大增加谵妄的发生率，同时会出现不同程度的术后脑功能障碍，其主要表现形式多为意识障碍、认知障碍和精神运动障碍等。随着中国的老年人口数越来越多，由高龄人群带来的认知功能障碍问题持续增加。尽管麻醉下脑氧耗降低，但仍会给患者带来一定程度的脑功能损伤，从而将引起患者发生术后认知功能障碍。而在机械通气期间进行肺保护性通气策略可改善老年患者脑氧平衡状态，从而降低术后认知功能障碍的发生率。因此，许多研究者建议应采用特定的通气策略，从而尽可能有效地打开萎陷的肺泡并维持其开放。而阶梯式肺复张能够有效缩短机械通气时间，使患者获益。本文对阶梯式肺复张策略在老年患者中的临床应用及研究进展进行了综述。
There are reports indicating that mechanical ventilation can greatly increase the incidence of de-lirium, while also leading to varying degrees of postoperative brain dysfunction, which mainly man-ifests as consciousness disorders, cognitive disorders, and psychomotor disorders. With the in-creasing number of elderly people in China, cognitive impairment problems caused by the elderly population continue to increase. Although cerebral oxygen consumption decreases under anesthe-sia, it can still cause a certain degree of brain function damage to patients, leading to postoperative cognitive dysfunction. Implementing lung protective ventilation strategies during mechanical ven-tilation can improve the brain oxygen balance of elderly patients during mechanical ventilation, thereby reducing the incidence of postoperative cognitive impairment. Therefore, many research-ers suggest adopting specific ventilation strategies to effectively open and maintain the opening of collapsed alveoli as much as possible. Stepwise lung recruitment can effectively shorten mechanical ventilation time and benefit patients. This article provides a review of the clinical application and research progress of the stepwise lung recruitment strategy in elderly patients.