心肺功能对行腹腔镜胃癌根治术患者手术耐受性的影响

Effect of cardiopulmonary function on operation tolerance of patients undergoing laparoscopic radical resection for gastric cancer

目的分析心肺功能对行腹腔镜胃癌根治术患者手术耐受性的影响。方法选择2012年2月至2016年11月在天津医科大学肿瘤医院实施腹腔镜胃癌根治术的患者72例，根据术前心肺功能评估结果分为心肺功能正常组、心功能异常组、肺功能异常组、心肺功能异常组。于入院时（TO）、麻醉并给予患者吸氧后进行气腹前10min（T1）和气腹后1h（T2）、2h（T3）、3h（T4）取桡动脉血，采用血气分析仪检测各时间点平均动脉压（MAP）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）的水平，并观察各组头晕头痛、胸闷胸痛、高碳酸血症等并发症的发生情况。结果各组患者MAP和PaO2从T1时起、PaCO2从T2时起即开始升高，直至rr4时仍明显高于TO时；心肺功能正常组、心功能异常组和肺功能异常组MAP（mmHg，1mmHg=O．133kPa）均于T1时达峰值（分别为96.3±6．7、97．2±5．9、98．8±6．8]，心肺功能异常组MAP于T3时达峰值为（117．1±7．6）mmHg，心肺功能正常组、心功能异常组、肺功能异常组和心肺功能异常组PaO2（mmHg）水平均于T1时达峰值（分别为553．1±76．7、544．2±51．8、548．6±61．8、449．1±62．3）。TO时心功能异常组、心肺功能异常组患者MAP均高于心肺功能正常组和肺功能异常组（mmHg：90．9±6．9、91．1±7-3比86．4±7．1、86．8±5．7），肺功能异常组和心肺功能异常组PaO2水平均明显低于心肺功能正常组（mmHg：85．8±5．7、77．1±7.3比98．4±2．1），肺功能异常组和心肺功能异常组PaCO2水平均明显高于心肺功能正常组（mmHg：38．9±4．7、39．7±4.3比37．4±23）；从T1时开始心肺功能正常组、心功能异常组、肺功能异常组和心肺功能异常组患者MAP（分别为96．3±6．7、97．2±5．9、98．8±6．8、99．2±813）和PaCO2（分别为34．6±2．7、34．8±3．5、44．2±2．8、44．9±23.3）均依次升高，Pa02从T2时开始依次降低（分别为527．4±68．8、524．8±78.3、397．2±71．9、283．7±73．2），其中肺功能异常组和心肺功能异常组PaO2显著低于心肺功能正常组，PaCO2明显高于心肺功能正常组（均P〈0．05）。各组并发症发生率按心肺功能正常组、心功能异常组、肺功能异常组、心肺功能异常组依次升高[0、4．76％（1／21）、17．64％（3／17）、43．75％（7／16），均P〈0．05]。结论心肺功能正常患者对腹腔镜胃癌根治术的耐受性最好，心功能异常患者的耐受性较好，肺功能异常患者的耐受性较差，心肺功能异常患者的耐受性最差。

Objective To analyze the effect of cardiopulmonary function on the tolerance of patients undergoing laparoscopic radical resection for gastric cancer. Methods Seventy-two patients ready to undergo laparoscopic radical resection for gastric cancer admitted to Tianjin Medical University Cancer Hospital from February 2012 to November 2016 were enrolled. According to the results of preoperative cardiopulmonary function evaluation, they were divided into four groups： group A with normal cardiopulmonary function, group B with abnormal cardiac function, group C with abnormal pulmonary function and group D with abnormal eardiopulmonary function. On admission, the time point was 0 （TO）, afterwards anesthesia and oxygen inhalation were applied to the patient, and then pneuinoperitoneum was carried out, the following were the time points after admission： 10 minutes before pneumoperitoneum （T1）, 1 hour after pneumoperitoneum （T2）, 2 hours after pneumoperitoneum （T3）, and 3 hours after pneumoperitoneum （T4）; blood was collected from the radial artery, the levels of mean arterial pressure （MAP）, the arterial partial pressure of oxygen （PaO2） and the arterial partial pressure of carbon dioxide （PaCO2） were detected at each time point in the four patient groups by blood gas analyzer, and the occurrences of complications such as dizziness headache, chest lightness chest pain and hypercapnia were observed. Results From the time of T1, the levels of MAP and PaO2 of each group were significantly higher than those at TO, and from T2 the level of PaCO2 in each group was obviously higher than that at TO （all P 〈 0.05）; MAP （mmHg, 1 mmHg = 0.133 kPa） of group A, B and C reached the peak at TI （96.3 ±6.7, 97.2±5.9, 98.8 ± 6.8）, and the MAP of group D reached peak at T3 was （117.1 ± 7.6） mmHg; the peaks of PaO2 （mmHg） levels in all A, B, C and D groups lached the peak at T1 （553.1 ±6.7, 544.2±51.8, 548.6±61.8, 449.1 ±62.3）. At TO, the levels of MAP of group B and group D were significantly higher than those of group A and group C （mmHg： 90.9± 6.9, 91.1 ±7.3 vs. 86.4 ± 7.1, 86.8 ± 5.7）, the PaO2 levels in group C and group D were significantly lower than that of group A （mmHg： 85.8 ± 5.7, 77.1 ± 7.3 vs. 98.4±2.1）, and PaCO2 levels in group C and group D were significant higher than the PaCO2 level in group A （mmHg： 38.9±4.7, 39.7±4.3 vs. 37.4±2.3）; from T1, the levels of MAP and PaCO2 in A, B, C and D groups [MAP （mmHg） was 96.3 ± 6.7, 97.2 ± 5.9, 98.8 ± 6.8, 99.2± 8.3, PaCO2 （mmHg） was 34.6 ± 2.7, 34.8 ± 3.5, 44.2 ± 2.8, 44.9 ± 2.3, respectively] were successively increased, and PaO2 levels from T2 were successively decreased [PaO2 （mmHg）： 527.4±68.8, 524.8± 78.3, 397.2±71.9, 283.7±73.2], in which PaO2 of group C and group D were significant lower than the PaO2 level in group A, while PaCO2 levels of group C and D were significant higher than PaCO2 level of group A （all P 〈 0.05）. The ineidenees of complications in A, B, C, D groups were increased sequentially [0, 4.76% （1/21）, 17.64% （3/17）, 43.75% （7/16）, all P 〈 0.05]. Conclusion Patients with normal cardiopulmonary function have the best toleranee to laparoseopie radical resection for gastrie cancer, patients with abnormal cardiac funetion have relatively good tolerance, patients with abnormal pulmonary function have relatively poor tolerance and the patients with eardiopulmonary dysfunction have the poorest toleranee.