肺保护性通气用于老年腹腔镜结直肠癌手术患者的临床观察

Clinical observation of lung protective ventilation in elderly patients undergoing laparoscopic colorectal cancer surgery

目的探讨肺保护性通气策略(LPVS)用于老年腹腔镜结直肠癌手术患者对肺功能改善效果及术后肺部并发症(PPCs)发生情况。方法回顾性分析2017年10月—2018年10月兰州市第一人民医院和陕西省肿瘤医院60例老年腹腔镜结直肠癌手术患者临床资料,根据不同通气模式分为观察组和对照组,每组30例。气腹期间观察组以VT 6mL/kg+5cm H2O呼气末正压(1cm H2O=0.098kPa)及每隔30min一次肺复张的模式通气,对照组以VT 6mL/kg模式通气。记录气管插管后1min(T1)、建立人工气腹后60min(T3)、手术结束前5min(T4)、拔管后10min(T5)氧合指标;T1、建立人工气腹后5min(T2)、T3、T4呼吸力学指标;术后48h及7d内PPCs发生情况。结果与T1时刻比较,T4、T5时刻PaO2明显下降;与对照组比较,T3时刻观察组PaO2明显升高,PA-aDO2明显降低,OI明显升高。与T1时刻比较,T2、T3时刻2组Cdyn明显降低,Ppeak明显增高,T2、T3时刻对照组PETCO2明显升高;与对照组比较,T2、T3时刻观察组Cdyn明显升高,T2~T4时刻观察组Ppeak明显下降。术后48h观察组肺部感染、低氧血症的发生率明显低于对照组;2组患者肺不张、延迟拔管率比较差异无统计学意义;术后7d 2组PPCs发生率比较差异无统计学意义。结论 LPVS用于老年腹腔镜结直肠癌手术患者能改善肺功能,明显减少PPCs发生。

Objective To probe into the effect of lung protective ventilation strategy(LPVS) on improving pulmonary function and occurrence of postoperative pulmonary complications(PPCS) in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods The clinical data of 60 elderly patients undergoing laparoscopic colorectal cancer surgery in the First People’ s Hospital of Lanzhou city and Shaanxi provincial Cancer Hospital from October 2017 to October 2018 were retrospectively analyzed. Both the observation group and the control group included 30 cases. During the pneumoperitoneum period, the observation group was ventilated with VT 6mL/kg combined with 5 cm H2O positive end-expiratory pressure(PEEP) and received lung recruitment every 30 minutes, while the control group was ventilated with VT 6mL/kg mode ventilation. The oxygenation indexes were recorded 1 minute after tracheal intubation(T1), establishment of artificial pneumoperitoneum 60 minutes(T3), 5 minutes before the end of operation(T4) and 10 minutes after extubation(T5). Respiratory mechanics indexes were recorded at T1, establishment of artificial pneumoperitoneum 5 minute(T2), T3, T4.The PPCs were recorded within 48 hours and 7 days after surgery. Results Compared with T1, the partial pressure of O2(PaO2) values of both groups were significantly decreased at T4 and T5. Compared with control group, the PaO2 values was significantly increased, calculated alveolar-arterial oxygen partial pressure(PA-aCO2) was significantly decreased, whereas the oxygenation index(OI) was significantly increased in observation group at T3. T1, dynamic lung cdyniance(Cdyn) of both groups were significantly decreased and the airway peak pressure(Ppeak) of both groups were significantly increased at T2 and T3, end-tidal carbon dioxide pressure(PETCO2) of control group was significantly increased at T2 and T3. Compared with control group, Cdyn was significantly increased in observation group at T2 and T3, Ppeak was significantly decreased in observation group at T2, T3 and T4. The incidence of pulmonary infection and hypoxemia in observation group was significantly lower than that in control group 48 hours after operation, and there was no significant difference in atelectasis and delayed extubation between the two groups. There was no significant difference in PPCs between the two groups on the 7 day after operation. Conclusion For elderly patients undergoing laparoscopic colorectal cancer surgery, LPVS can improve pulmonary function and significantly reduce the incidence of PPCs.