腹腔镜下食管裂孔疝并发胃食管返流患者肺通气功能行保护性康复的疗效

Evaluation of protective rehabilitation intervention for pulmonary ventilation function in patients undergo⁃ing laparoscopic hiatal hernia repair complicated with GRED

目的评估腹腔镜下食管裂孔疝并发胃食管返流(GRED)患者针对其肺通气功能行保护性康复干预的临床效果。方法选取我院2017年8月至2019年3月收治的68例腹腔镜下食管裂孔疝合并GRED患者作为研究对象。随机分为两组,保护组34例,实施保护性康复干预,容量组34例,实施传统容量控制性康复干预。观察并记录两组患者气腹前(t_(0))、气腹后2 h(t_(1))、4 h(t_(2))、术后24 h(t_(3))的平均动脉压(MAP)、中心静脉压(CVP)、肺顺应性(C)、肺泡⁃动脉血氧分压差(A⁃aDO2)、呼气末二氧化碳分压(P_(ET)CO_(2))、氧合指数(OI)、心率(HR)和呼吸频率(RR)及相关并发症发生情况,并结合术后住院天数综合评价患者术后康复效果。结果与t_(0)相比,患者术后MAP和CVP均明显升高,C明显降低(P<0.05);t_(1)、t_(2)时刻保护组C的降幅大于容量组(P<0.05)。与t_(0)相比,患者A⁃aDO2和P_(ET)CO_(2)均明显降低(P<0.05);t_(1)、t_(2)、t_(3)时刻保护组A⁃aDO2和P_(ET)CO_(2)降幅大于容量组(P<0.05)。与t_(0)相比,患者OI和RR均明显升高,保护组HR在t_(1)、t_(2)时刻明显降低(P<0.05),容量组HR各时段变化值与t_(0)时刻相比差异无统计学意义(P>0.05);t_(1)、t_(2)、t_(3)时刻保护组OI、RR增幅大于容量组(P<0.05)。保护组相关并发症累计发生率、住院天数均低于容量组(P<0.05)。结论保护性康复干预更有利于腹腔镜下食管裂孔疝合并GRED患者的肺通气功能恢复,值得推广。

Objective To evaluate the clinical effect of protective rehabilitation intervention for pulmonary ventilation function in patients undergoing laparoscopic hiatal hernia repair complicated with GRED.Methods Sixty⁃eight patients undergoing laparoscopic hiatal hernia repair(LHHR)complicated with GRED who were admitted to our hospital from August 2017 to March 2019 were selected as the research object.They were randomly divided into protection group and volume group,with 34 in each group.The mean arterial pressure(MAP),central venous pressure(CVP),pulmonary compliance(C),alveolar⁃arterial differential blood oxygen pressure(A⁃ADO2),end⁃expiratory partial pressure of carbon dioxide(P_(ET)CO_(2)),oxygenation index(OI),and pulmonary compliance(C)were observed and recorded before pneumoperitoneum(T_(0)),2 h(T_(1)),4 h(T_(2))and 24 h(T_(3))after pneumo⁃peritoneum in the 2 groups.The incidence of heart rate(HR),respiratory rate(RR)and related complications,combined with the length of postoperative hospital stay,were evaluated for the postoperative rehabilitation effect.Results Compared with those before pneumoperitoneum(T_(0)),postoperative MAP and CVP were significantly increased,while C was significantly decreased(P<0.05).At T_(1) and T_(2),the decrease of C in protection group was greater than that in volumn group(P<0.05).Compared with those before pneumoperitoneum,a⁃ADO2 and P_(ET)CO_(2) were significantly decreased in patients(P<0.05).At T_(1),T_(2) and T_(3),the decrease of A⁃ADO2 and P_(ET)CO_(2) in the protection group was greater than that in the capacity group(P<0.05).Compared with those before pneumoperito⁃neum,OI and RR were significantly increased,and HR in the protection group was significantly decreased at T_(1) and T_(2)(P<0.05),while the change of HR in the volume group at T_(1),T_(2) and T_(3) was insignificant when compared with that before pneumoperitoneum(P>0.05).At T_(1),T_(2) and T_(3),OI and RR of the protection group increased more than those of the volume group(P<0.05).There were lower cumulative incidence of related complications and less hospitalization days in the protection group(P<0.05).Conclusion Protective rehabilitation intervention is conducive to the recovery of pulmonary ventilation in patients undergoing LHHR complicated with GRED,which is worthy of promotion.