麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响OACSTPCD
Impact of Different Inspired Oxygen Concentrations during Anesthetic Emergence on Postoperative Atelectasis in Patients Undergoing Laparoscopic Radical Gastrectomy for Gastric Cancer
目的 探讨麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响.方法 选择行择期腹腔镜下胃癌根治术的老年患者68例,随机分为两组:高吸入氧浓度组(C组)和低吸入氧浓度组(L组),每组34例.在麻醉苏醒期间,L组采用40％吸入氧浓度,C组采用100％吸入氧浓度.采用床旁肺超声评估患者12个区域(左肺和右肺各6个区域)的肺超声评分(LUS).记录入室时(T0)、术后30 min(T4)的LUS评分及术后肺不张的发生率.记录入室(T0)、气腹结束时(T1)、拔管时(T2)、出PACU时(T3)的心率(HR)、平均动脉压(MAP),血气分析记录血氧分压(PaO2),计算氧合指数(O1).记录拔管后在PACU中SpO2＜94％事件的发生率.于术前1 d(D0)和术后1 d(D1)、3 d(D2)、5 d(D3)测定第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、1秒率(FEV1/FVC).记录术后1 d临床肺部感染评分(CPIS)和术后7 d肺部并发症的发生情况.结果 L组和C组从气腹结束至拔管时间分别为(36.4±5.2)min和(37.3±4.2)min(P＞0.05).与C组相比,L组在T4时的肺超声评分及肺不张发生率明显降低(P＜0.05).L组在T3时,PaO2、OI均明显升高(P＜0.05).在PACU中L组SpO2＜94％事件的发生率低于C组(P＜0.05).与D.时比较,D1-3两组患者的FEV1、FVC、FEV1/FVC均明显降低(P＜0.05),与C组比较,L组在D1时FEV1、FVC、FEV1/FVC均明显升高(P＜0.05).术后1 d CPIS评分和术后7 d肺部并发症发生率两组无明显差异(P＞0.05).结论 麻醉苏醒期间低吸入氧浓度能降低老年患者腹腔镜胃癌根治术术后肺不张的发生率及严重程度,改善术后早期肺功能.
Objective To investigate the influence of different inspired oxygen concentrations during anesthetic emergence on postoperative atelectasis in elderly patients undergoing elective laparoscopic radical gastrectomy for gastric cancer.Methods Sixty-eight elderly patients scheduled for elective laparoscopic radical gastrectomy were randomly as-signed to either the high inspired oxygen concentration group(Group C)or the low inspired oxygen concentration group(Group L)with 34 patients in each group.During anesthetic emergence,Group L received 40％inspired oxygen,while Group C received 100％inspired oxygen.Bedside lung ultrasound was used to assess lung ultrasound scores(LUS)in 12 regions(6 in each lung)at entry(T0)and 30 minutes postoperatively(T4).The occurrence of postoperative atelectasis was recorded.Heart rate(HR),mean arterial pressure(MAP),and blood gas analysis including oxygen partial pressure(PaO2)and oxygenation index(OI)were documented at entry(T0),end of pneumoperitoneum(T1),extubation(T2),and PACU discharge(T3).The incidence of SpO2＜94％events in the PACU was recorded.Forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),and FEV1/FVC were measured at preoperative day 1(D0)and postop-erative days 1(D,),3(D2),and 5(D3).Clinical Pulmonary Infection Score(CPIS)on postoperative day 1 and the incidence of pulmonary complications on postoperative day 7 were recorded.Results The time from the end of pneumo-peritoneum to extubation was comparable between Group L(36.4±5.2 min)and Group C(37.3±4.2 min)(P＞0.05).Compared with Group C,Group L showed significantly lower LUS and lower incidence of postoperative atelectasis at T4(P＜0.05).At T3,Group L demonstrated significantly increased PaO2 and OI(P＜0.05).The incidence of SpO2＜94％events in the PACU was lower in Group L than in Group C(P＜0.05).Compared with D0,FE V,,FVC,and FEV1/FVC were significantly reduced in both groups on D1-3(P＜0.05).Compared with Group C,Group L showed significantly increased FEV,,FVC,and FEV1/FVC at D,(P＜0.05).There were no significant differences in CPIS on postoperative day 1 and the incidence of pulmonary complications on postoperative day 7 between the two groups(P＞0.05).Conclusion During anesthetic emergence,low inspired oxygen concentration reduces the incidence and severity of postoperative atelectasis in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer,improving early postoperative lung function.
蔡信杰;郭文雅;汪洋;李云
安徽医科大学第二附属医院麻醉与围术期医学科(安徽合肥 230601)
临床医学
吸入氧浓度麻醉苏醒期肺部超声老年胃癌肺功能
inhaled oxygen concentrationemergencelung ultrasoundelderlygastric cancerlung function
《广东医学》 2024 (002)
194-199 / 6
安徽高校自然科学研究项目(KJ2019ZD24)
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