保护性肺通气对老年腹腔镜结直肠癌手术患者术后肺氧合功能的影响

Effects of lung protective ventilation on postoperative pulmonary oxygenation in elderly patients after laparoscopic colorectal cancer surgery

关键词:  老年患者  腹腔镜  结直肠癌手术  保护性肺通气  氧合功能

Key words:  elderly patients  laparoscopy  colorectal cancer surgery  protective lung ventilation  postoperative pulmonary oxygenation

摘要:

目的　评估术中保护性肺通气策略对老年腹腔镜结直肠癌手术患者术后早期肺氧合功能的影响。方法　选择60例择期行全麻腹腔镜结直肠癌根治术治疗的老年患者,分为两组：常规通气组（C组）和保护性肺通气组（P组），每组30例。C组VT 8 mL/kg，不使用呼气末正压（PEEP）和肺复张；P组VT 6 mL/kg，PEEP 5 cmH2O以及每隔40 min进行1次肺复张。记录两组患者术中气道压(Ppeak)和肺顺应性(CL）；记录两组患者术前（T1）、术后24 h（T2）、48 h(T3)的脉搏血氧饱和度（SpO₂）、动脉氧分压（PaO₂）、肺泡动脉血氧分压差［P(A-a)DO₂］、血白细胞计数（WBC）以及C反应蛋白（CRP）；记录T1、T3时刻改良临床肺部感染评分（mCPIS）；同时记录术中不良事件以及术后48 h内呼吸系统并发症（PPCs）的发生情况。结果　两组患者术中输液量、出血量以及手术时间差异无统计学意义；术中P组气道压显著低于C组；P组肺顺应性显著高于C组，差异有统计学意义P＜0.05）；术后T2、T3时刻P组的SpO₂及PaO₂明显高于C组；P(A-a)DO2明显低于C组，差异有统计学意义P＜0.05）；与T1时刻相比，两组患者T2、T3时刻CRP水平及WBC明显升高P＜0.05），T2、T3时刻P组CRP水平均明显低于C组P＜0.05），而WBC两组之间无明显差异P>0.05）；P组T3时刻mCPIS评分以及术后48 h内呼吸系统并发症的发生率明显低于C组P＜0.05）；两组术中均无严重不良事件的发生。结论　对于行腹腔镜结直肠手术的老年患者术中应用保护性的肺通气策略有利于促进术后早期肺氧合功能的恢复，降低呼吸系统并发症的发生率。

Abstract:

Objective To evaluate the effects of lung protective ventilation on early postoperative pulmonary oxygenation in elderly patients after laparoscopic colorectal cancer surgery. Methods Sixty elderly patients, scheduled for selective laparoscopic colorectal cancer surgery were randomly divided into non-lung protective ventilation group (group C) and lung protective ventilation group (group P) with 30 patients in each group. After anesthesia, the mechanical ventilation parameters in group P were tidal volume (VT) 6 mL/kg and end-expiratory pressure (PEEP)5 cmH₂O, while the VT was set to 8 mL/kg without PEEP in the group C. Patients in group P received lung recruitment every 40 minutes. The values of airway pressure (Ppeak) and lung compliance (CL) during operation were recorded. Pulse oxygen saturation (SpO₂), partial pressure of O₂(PaO₂), oxygen pressure difference between alveolar and arterial (P(A-a)DO₂), WBC and C-reactive protein (CRP) before operation (T1), 24h after operation (T2) and 48h after surgery (T3) were recorded. The modified clinical pulmonary infection score (mCPIS) before surgery and 48h after surgery were evaluated. The adverse events during operation and the pulmonary complications after surgery (PPCs) were also be observed. Results The infusions, bleeding and the operation time had no significant differences between the two groups (P>0.05). Compared with group C, the Ppeak during surgery in group P were significantly decreased, and the CL were significantly increased (P＜0.05). Compared with T1, the values of SpO₂and PaO₂ at T2 in both groups were significantly decreased and P(A-a)DO2 were significantly increased (P＜0.05). The values of SpO2 and PaO2 at T2, T3 in group P were significantly higher than those in group C, and P(A-a)DO₂ in group P were significantly lower than those in group C (P＜0.05). The CRP and WBC at T2, T3 in each group were significantly increased when compared those with T1, the CRP at T2, T3 in group P were significantly lower than those in group C (P＜0.05), however there was no significant difference in WBC between two groups (P>0.05). Compared with group C, the mCPIS score at T3 and the incidence of PPCs over 48 h postoperative period in group P were significantly decreased (P＜0.05). There were no adverse events in each group during the surgery. Conclusion The administration of lung protective ventilation during surgery is beneficial to improve the early postoperative recovery of postoperative pulmonary oxygenation and reduce the incidence of PPCs in elderly patients with laparoscopic colorectal surgery.