气腹对老年结直肠癌患者肺顺应性和肺内分流率的影响  

Effects of Pneumoperitoneum on Lung Compliance and Intrapulmonary Shunt in Elderly Patients with Colorectal Cancer

作　　者：李锋[1] 朱蔚琳[1] 黄中华[1] 张学刚[1] 宁加娟[1] 包延丽[1] 

机构地区：[1]广西壮族自治区人民医院麻醉科,南宁市530021

出　　处：《广西医学》2014年第12期1728-1730,共3页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z2008081)

摘　　要：目的探讨气腹对老年人肺顺应性和肺内分流率的影响。方法 ASAⅠ～Ⅱ级老年结直肠癌患者46例,按住院号单双随机分为观察组（气腹组）和对照组（开腹组）,每组23例。两组患者均采用气管内插管全麻,气管插管后均采用纯氧间歇正压通气。分别于术前（T0）和手术开始后30 min（T1）、60 min（T2）、120 min（T3）、术毕后30 min（T4）测定气道峰压（Ppeak）和气道平台压（Pplat）,计算肺顺应性（CL）,并于上述时间点抽取桡动脉和中心静脉血作血气分析,计算各时点肺内分流率（QS/QT）。结果观察组T1、T2、T3时间点Ppeak、Pplat值明显高于对照组同一时间点（P〈0.01）,T1、T2、T3时间点CL值明显低于对照组同一时间点（P〈0.01）;观察组T1、T2、T3、T4时间点QS/QT值明显大于对照组同一时间点（P〈0.01）。结论老年人腹腔镜结直肠癌根治术中气腹对肺顺应性和肺内分流率产生明显影响,术中及复苏期均需加强呼吸管理。Objective To investigate the effects of pneumoperitoneum on senile pulmonary compliance and intrapulmonary shunt. Methods Forty-six elderly patients with ASAⅠ-Ⅱ colorectal cancer were randomly divided into observation group（ laparoscopic group） and control group（ open group） according to their admission number,with 23 cases in each group. The patients in two groups received endotracheal intubation anesthesia which was followed by pure oxygen intermittent positive pressure ventilation（ IPPV）. Peak airway pressure（ Ppeak） and airway plateau pressure（ Pplat） were determined at 5 time points,respectively,preoperative（ T0）,the 30th（ T1）,60th（ T2） and 120 th minute（ T3） during surgery,and 30 minutes（ T4）after surgery. And then lung compliance（ CL） was calculated. Blood samples were collected from radial artery and central venous at the 5 time points,respectively,for a blood gas analysis. Intrapulmonary shunt fraction（ QS / QT） of each time point was calculated. Results The Ppeak and Pplat values at T1,T2,T3 of observation group were significantly higher than those of control group（ P〈0. 01）. The CL values at T1,T2,T3 of observation group were significantly lower than those of control group（ P〈0. 01）. The QS / QT values at T1,T2,T3,T4 of observation group were significantly higher than those of control group（ P〈0. 01）. Conclusion Pneumoperitoneum occurs in the laparoscopic resection has a significant effect on lung compliance and intrapulmonary shunt among elderly patients with colorectal cancer. It is necessary to strengthen the respiration management during operation and recovery period.

关 键 词：结直肠癌 腹腔镜 呼吸功能 肺顺应性 肺内分流率 

分 类 号：R735.3[医药卫生—肿瘤]