ИНТРАОПЕРАЦИОННАЯ ПРОТЕКТИВНАЯ ИСКУССТВЕННАЯ ВЕНТИЛЯЦИЯ ЛЕГКИХ В АБДОМИНАЛЬНОЙ ХИРУРГИИ

Искусственная вентиляция легких (ИВЛ) является одним из основных методов интенсивной терапии, но существенно отличается от естественного внешнего дыхания и может способствовать возникновению послеоперационных легочных осложнений (ПОЛО). Целью обзора является оценка эффективности протективной ИВЛ в целом и отдельных ее компонентов (малый дыхательный объем, высокое положительное давление в конце выдоха (ПДКВ), маневр мобилизации альвеол) в снижении риска развития ПОЛО у пациентов с интактными легкими в абдоминальной хирургии. Заключение. Протективная ИВЛ в периоперационном периоде при абдоминальных операциях уменьшает частоту послеоперационных легочных осложнений, но не влияет на летальность. Основным компонентом протективной ИВЛ признается использование малого дыхательного объема, в то время как применение высокого ПДКВ и маневров мобилизации альвеол при открытых вмешательствах у больных без ожирения остается предметом дискуссий. В лапароскопической хирургии и у пациентов с избыточной массой тела обоснованным подходом представляется сочетание малого дыхательного объема с высоким ПДКВ и маневрами мобилизации альвеол.

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