不同吸入氧浓度对行腹腔镜下结肠癌根治术老年病人术后肺部并发症的影响

Influence of inhaled oxygen concentration on postoperative pulmonary complications in the elderly patients undergoing laparoscopic radical colonectomy

目的探讨30%吸入氧浓度(FiO_(2))与80%FiO_(2)对择期行腹腔镜下结肠癌根治术的老年病人术后肺部并发症(PPCs)的影响。方法选择择期行腹腔镜下结肠癌根治术的病人120例,美国麻醉医师协会分级为Ⅰ~Ⅱ级,年龄65~80岁,预计手术时间>1 h。将病人随机分为2组30%FiO_(2)组(L组)和80%FiO_(2)组(H组)。记录并比较2组病人术后7 d PPCs的发生率及其严重程度,同时记录术中液体入量、出血量、镇痛药物的使用量、手术及麻醉时间、术后恶心呕吐的发生率以及住院天数等。结果2组病人PPCs的发生率差异无统计学意义(P>0.05),但L组严重程度≥2级的比例低于H组,差异有统计学意义(P<0.05)。2组术中情况比较,差异均无统计学意义(P<0.05)。结论术中30%和80%的FiO_(2)对择期行腹腔镜下结肠癌根治术老年病人的PPCs的发生率没有影响,但术中30%的FiO_(2)可降低PPCs的严重程度。

Objective To investigate the influence of low oxygen concentration(30%)and high oxygen concentration(80%)on postoperative pulmonary complications(PPCs)in the elderly patients undergoing laparoscopic radical colonectomy.Methods A total of 120 patients aged 65-80 years old who underwent laparoscopic radical resection of colon cancer were selected,with an American Society of Anesthesiologists gradeⅠ-Ⅱand the expected operation time was more than 1 h.The patients were randomly divided into 30%fraction of inspiration oxygen(FiO_(2))group(L group)and 80%FiO_(2) group(H group).The incidence and the severity of PPCs of the two groups 7 days after operation was recorded and compared,as well as the intraoperative fluid infusion volume and blood loss,duration of surgery and anesthesia,dosage of analgesics,incidence of postoperative nausea and vomiting,and length of hospital stay.Results The incidence rate of PPCs,including lung infection,atelectasis,pleural effusion,pneumothorax and respiratory failure,was not significantly different between the two groups(P>0.05).The incidence rate of PPCs with grade 2 and above in L group was significantly lower than that in H group(P<0.05).There were no significant differences in the intraoperative fluid infusion volume,blood loss,duration of surgey,dosage of analgesics,hospital stay and other adverse reactions.Conclusions 30%FiO_(2) and 80%FiO_(2) show no different influence on the occurrence of PPCs in the elderly patients undergoing elective laparoscopic radical colonectomy,but 30%oxygen concentration can reduce the severity of PPCs.