肺保护性通气对妇科腹腔镜手术患者肺换气功能、血清克拉细胞分泌蛋白16水平及预后的影响

Effect of lung protective ventilation on lung ventilation function,serum serum Clara cell protein 16 level and prognosis in patients undergoing gynecological laparoscopic surgery

目的分析肺保护性通气对妇科腹腔镜手术患者肺换气功能、血清克拉细胞分泌蛋白16(CC16)水平及预后的影响。方法采用前瞻性研究的方法,选取2018年10月至2020年12月在盐域市建湖县人民医院行腹腔镜手术的妇科患者80例,按随机数字表法分为A、B组,每组40例。A组采用间歇正压机械通气模式进行肺保护性通气,B组采用全程通气模式进行通气,观察两组患者麻醉前、气腹10 min、气腹30 min、气腹停止5 min、术后2 h时患者肺换气功能、CC16水平及术后肺部并发症发生情况。根据患者是否发生肺部并发症进行分组,比较其肺换气功能、血清CC16水平,采用受试者工作特征(ROC)曲线分析上述指标对患者发生肺部并发症的预测价值。结果重复测量方差分析结果显示,A、B组肺泡-动脉氧分压差(PA-aDO_(2))在时点因素、交互因素、组别因素中差异均有统计学意义(P<0.05);CC16则在时点因素、组别因素中差异有统计学意义(P<0.05)。根据对患者术后至出院期间的观察,A组有4例(10.0%)患者发生肺部并发症,B组有15例(37.5%)患者发生肺部并发症,两组发生并发症患者PA-aDO_(2)、CC16水平均高于未发生并发症患者[A组:(332.9±2.0)mmHg(1 mmHg=0.133 kPa)比(290.4±13.0)mmHg,(53.5±1.5)μg/L比(39.5±6.5)μg/L;B组:(339.1±8.8)mmHg比(330.7±17.9)mmHg,(41.5±4.2)μg/L比(39.7±5.8)μg/L],差异有统计学意义(P<0.05)。ROC曲线分析显示,PA-aDO_(2)、CC16预测A组患者发生肺部并发症的曲线下面积(AUC)为0.882、0.833,预测B组患者发生肺部并发症的AUC为0.885、0.731。结论肺保护性通气对妇科腹腔镜手术患者肺换气功能、血清CC16水平影响较小,患者发生肺部并发症概率较低。而肺换气功能、血清CC16水平对预测患者术后发生肺部并发症具有一定价值。

Objective To analyze the effect of lung protective ventilation on lung ventilation function and serum Clara cell protein 16(CC16)level in patients undergoing gynecological laparoscopic surgery.Methods The clinical data of 80 gynecological patients who underwent laparoscopic surgery in Yancheng City Jianhu County People′s Hospital from October 2018 to December 2020 were randomly divided into group A and group B by random number table,each group with 40 cases.The patients in group A were treated with intermittent positive-pressure ventilation,and the patients in group B were ventilated with whole course ventilation mode.The pulmonary ventilation function,CC16 level and postoperative pulmonary complications were observed before anesthesia,10 min of pneumoperitoneum,30 min of pneumoperitoneum,5 min of pneumoperitoneum stop and 2 h after operation.The patients were divided into groups according to whether with pulmonary complications,and their pulmonary ventilation function and serum CC16 level were compared.The predictive value of the above indexes for pulmonary complications was analyzed by receiver operating characteristic(ROC)curve.Results Repeated measurement analysis of variance showed that alveolar arterial oxygen differential pressure(PA-aDO_(2))were significant differences in time point factors,time point interaction factors and group factors(P<0.05);CC16 index were significant differences in time point factor and group factor(P<0.05).According to the observation from postoperative to discharge,4 patients(10.0%)in group A had pulmonary complications,15 cases(37.5%)had pulmonary complications in group B,the levels of PA-aDO_(2)and CC16 in patients with complications were significantly higher than those in patients without complications:group A:(332.9±2.0)mmHg(1 mmHg=0.133 kPa)vs.(290.4±13.2)mmHg,(53.5±1.5)μg/L vs.(39.5±6.5)μg/L;group B:(339.1±8.8)mmHg vs.(305.7±17.9)mmHg,(41.5±4.2)μg/L vs.(39.7±5.8)μg/L,there were statistical differences(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of PA-aDO_(2)and CC16 in predicting pulmonary complications in group A were 0.882 and 0.833,in group B was 0.885 and 0.731.Conclusions Lung protective ventilation has little effect on lung ventilation function and serum CC16 in patients with gynecological laparoscopic surgery,and the probability of pulmonary complications is lower.The pulmonary ventilation function and CC16 have certain value in predicting postoperative pulmonary complications.