食管癌围术期多脏器功能指标在不同海拔地区的变化及意义

Changes and clinical significance of multi-organs dysfunctional indices during peri-operation period in patients with esophageal cancer at different altitude

目的探讨食管癌围术期平原地区和中度高原地区(1517m)多器官功能指标参数的变化规律。方法按统一标准对44例拟行开胸食管癌切除胃食管吻合术病例,根据所在地区分为平原对照组(FCG,8例)、中度高原对照组(MCG,20例)和中度高原肺保护组(MTG,16例),FCG组和MCG组均按常规进行围术期肺功能检查、呼吸道准备。MTG组除上述常规准备外另于术前每日2次服用复方红景天胶囊2粒。3组均按计划采集术前、术后1、3、5d血气和多器官生化指标。结果术前和术后3组的血气差异均有统计学意义,P<0·01,其他多器官功能指标术前差异无统计学意义,P>0·05,但术后1、3、5d MCG和MPG的变化也明显重于FCG,P<0·05。结论同类手术,手术前、后多器官功能指标参数有随海拔上升而加重的趋势,其中尤以血气指标较显著,提示海拔≥1517m时在评估病情发展,判别ARDS/MODS诊断标准上是一个有意义的分界线,值得临床参考。

Objective Aims To investigate the dynamic changes of multi-organ functional indices in esophageal carcinoma patients during peri-operation period at flatland and moderate high altitude. Methods 44 cases of esophageal carcinoma scheduled to receive gastroesophagostomy were categorized semi-randomly into three groups： Flatland control group （FCG, n = 8）, moderate altitude lung protection group （ MPG, n = 16）, moderate altitude control group （ MCG, n = 20）. The cases in FCG and MCG underwent routine pulmonary function examination and respiratory tract preparation peri-operatively. Besides the above routine treatment, the cases in MTG received administration of Rahdiika compound capsules preoperatively, with 2 pills a day. Blood-gas and biochemical indices of multi-organs were recorded in the three groups preoperatively and at 1, 3, and 5 days postoperatively respectively. The patients＇ systematic reaction, the changing trend of the indices reflecting organs function and the postoperative complication were observed. Restits The blood-gas parameters were different significantly both preoperatively and postoperatively between the three groups. While other indices reflecting the organs function were not different significantly between the three groups before the operation, but at 1, 3, 5 days postoperatively, the indices in MCG and MPG were significantly different with that in FCG （ P 〈 0. 05）. Conclusion For the same kind of operation, the indices indicating the organs function display an ascent tendency with the elevation of the altitude level both preoperatively and postoperatively, especially the blood-gas indices. It is suggested that the altitude level of 1517m is the critical ＂extreme＂ regarding the exact identification of the patient＇s condition and diagnosis of ARDS/MODS. More cases need to be enrolled for further investigation.