肺超声在老年患者腹腔镜结直肠癌手术中的应用

Application of lung ultrasound in laparoscopic colorectal cancer surgery in elderly patients

目的通过肺超声评估老年患者腹腔镜手术术后肺不张的发生率及严重程度,并评估肺超声在肺复张过程中的指导作用,为肺超声在围术期的应用提供依据。方法选取2018年9月~2019年9月在我院拟行腹腔镜结直肠癌手术的42例老年患者为研究对象,年龄60~80岁,美国麻醉师协会(ASA)Ⅱ或Ⅲ级。采用随机对照法分为两组:对照组(C组,n=21)和复张组(RM组,n=21)。两组分别在麻醉前(T_(1))、手术结束时(T_(2))、拔管后30 min(T_(3))3个时间点进行肺部超声十二分区法扫查,手术结束时(T_(2))RM组的肺不张患者在超声监测下行肺复张,C组不行肺复张。用肺超声分数评估肺不张严重程度以及发生率,记录T_(1)、T_(2)、T_(3)时的肺超声分数,记录PaO_(2)、SpO_(2)、手术时间、术中失血量、输液量及尿量。术中采取相同的麻醉方法和机械通气策略。结果①T_(2)时C组肺不张发生率95%,RM组肺不张发生率100%;两组比较,差异无统计学意义(P>0.05)。T_(3)时C组肺不张发生率95%,RM组肺不张发生率50%;两组比较,差异有统计学意义(P<0.05)。②T_(3)时RM组肺超声总分低于C组(P<0.001);左侧5区和6区、右侧5区和6区,RM组的肺超声分数小于C组(P<0.05);在RM组,T_(3)时肺超声总分小于T_(2)时(P<0.001)。③两组PaO_(2)、SpO_(2)、手术时间、失血量、输液量、尿量比较,差异无统计学意义(P>0.05)。结论老年患者腹腔镜结直肠癌手术术后肺不张的发生率极高,为100%。超声监测下肺复张能有效降低术后肺不张发生率,降低肺超声分数、肺不张严重程度及改善肺通气,肺超声可在围术期推广使用。

Objective To evaluate the incidence and severity of atelectasis in elderly patients after laparoscopic surgery by lung ultrasound,and evaluate the guiding role of lung ultrasound in the process of lung recruitment,so as to provide the basis for the application of lung ultrasound in perioperative period.Methods Forty-two elderly patients undergoing laparoscopic colorectal cancer surgery,aged 60-80 years old,falling into ASA physical statusⅡorⅢ,were selected in our hospital from September 2018 to September 2019.Random control method was used to divide them into control group(C group,n=21)and recruitment group(RM group,n=21).The two groups were scanned by lung ultrasound at 12 regions before anesthesia(T_(1)),at the end of the operation(T_(2)),and 30 minutes after extubation(T_(3)).At the end of the operation(T_(2)),patients with atelectasis in RM group underwent recruitment under ultrasound monitoring,and those in C group did not.Use lung ultrasound scores to assess the severity and incidence of atelectasis.lung ultrasound scores at T_(1),T_(2),T_(3),PaO_(2),SpO_(2),operation time,intraoperative blood loss,infusion volume and urine volume were recorded.The same anesthesia method and mechanical ventilation strategy were adopted during the operation.Results The incidence of atelectasis in group C and RM group were 95%and 100%at T_(2)(P>0.05).The incidence of atelectasis in group C and RM group were 95%and was 50%at T_(3)(P<0.001).The total lung ultrasound scores of group RM were lower than that of group C(P<0.001)at T_(3).The lung ultrasound scores of the RM group were less than the C group in the left 5 and 6 regions,the right 5 and 6 regions at T_(3)(P<0.05).In RM group,the total lung ultrasound scores at T_(3)were less than it at T_(2)(P<0.001).3.PaO_(2),SpO_(2).The operation time,blood loss,infusion volume and urine volume were not statistically significant.Conclusion The incidence of atelectasis in elderly patients after laparoscopic colorectal cancer surgery was 100%.Under ultrasound monitoring,lung recruitment can effectively reduce the incidence of postoperative atelectasis,reduce lung ultrasound score,severity of atelectasis and improve lung ventilation.