肺超声在预测老年患者术中不同液体治疗策略下肺损伤程度中的应用

Application of pulmonary ultrasound in predicting the degree of lung injury in elderly patients undergoing different fluid therapy strategies

目的观察不同液体治疗策略对行腹腔镜下结肠癌根治术老年患者术中肺功能的影响,探讨肺超声预测肺损伤程度的可行性。方法选择2017年5月至2018年8月腹腔镜下结肠癌根治术老年患者73例,男38例,女35例,年龄65~80岁,ASAⅡ或Ⅲ级。采用随机对照法分为两组:目标组(G组,n=37)和对照组(C组,n=36)。G组以每搏变异度(SVV)、MAP为指导,将CI≥2.5 L·min^-1·m^-2作为目标行目标导向液体治疗;C组以MAP、CVP、术中尿量为指导行常规输液。记录开气腹前(T0)、开气腹后(T1)、肠吻合时(T2)、关气腹前(T3)、关气腹后(T4)的PaCO2、PaO2、氧合指数(OI)、气道峰压(PIP),记录肺损伤程度评分、晶体入量、胶体入量、液体总入量、出血量、输血情况以及术后肺部并发症情况等。结果与C组比较,T2-T4时G组PaCO2明显降低,PaO2和OI明显升高(P<0.05);T3-T4时G组PIP明显降低,肺损伤程度评分明显降低(P<0.05)。与C组比较,G组晶体入量、胶体入量、液体总入量、出血量、术中需输血例数和术后肺水肿例数明显减少(P<0.05)。肺损伤程度评分与术后肺部并发症总例数呈明显正相关(r=0.534,P<0.001)。结论老年患者术中目标导向液体治疗,肺损伤程度轻,术后并发症少,同时联合肺超声技术,可及时准确评估肺损伤程度,更利于围术期肺保护,值得推广。

Objective To investigate the effects of different fluid therapy strategies on the intraoperative lung function in elderly patients undergoing laparoscopic radical colectomy and the feasibility of predicting the degree of lung injury by pulmonary ultrasound.Methods Seventy-three elderly patients undergoing laparoscopic radical resection of colon cancer,38 males and 35 females,aged 65-80 years,falling into ASA physical statusⅡorⅢ,were selected in our hospital from May 2017 to August 2018.They were randomized divided into target group(group G,n=37)and control group(group C,n=36).Group G was guided by stroke volume variation(SVV)and mean arterial pressure(MAP),received target row goal-directed liquid treatment with the goal of cardiac index(CI)≥2.5L·min^-1·m^-2.Group C received routine infusion guided by MAP,central venous pressure(CVP)and intraoperative urinary volume.The carbon dioxide pressure(PCO2),oxygen pressure(PaO2),oxygenation index(OI)and airway peak pressure(PIP)were recorded before opening pneumoperitoneum(T0),after opening pneumoperitoneum(T1),during intestinal anastomosis(T2),before closing pneumoperitoneum(T3)and after closing pneumoperitoneum(T4).The severity of lung injury score,the crystal and colloid dosage,total liquid volume,the amount of bleeding,the blood transfusion,and the postoperative lung complication situation were observed.Results Compared with group C,PCO2 of group G was significantly lower while PaO2 and OI were significantly higher at T2-T4(P<0.05),PIP and lung injury score were significantly reduced in group G at T3-T4(P<0.05).Compared with group C,the crystal and colloid dosage,total liquid volume,the amount of bleeding,the number of cases requiring blood transfusion during operation and the incidence of postoperative pulmonary edema was significantly reduced in group G(P<0.05).The score of lung injury degree was positively correlated with the total number of postoperative pulmonary complications(r=0.534,P<0.001).Conclusion By using goal-directed fluid therapy in the elderly patients,the degree of lung injury is slight,and fewer complications occurred.Combined with lung ultrasound technology,the degree of lung injury can be assessed timely and accurately which is more conducive to perioperative lung protection.Thus,it is worth popularizing.