老年肝癌切除术患者围术期应用纤维支气管镜吸痰对低氧血症及肺部感染的影响  

Effect on hypoxemia and lung infection by fiberoptic bronchoscopy suctioning in elderly patients underwent hepatectomy during perioperative period

作　　者：徐卉红 刘宇芳[2] 居旻杰[3] 屠国伟[3] 陆智杰[1] 邱海波[1] 

机构地区：[1]第二军医大学东方肝胆外科医院麻醉科,上海市200438 [2]解放军第101医院麻醉科 [3]复旦大学附属中山医院重症医学科

出　　处：《临床麻醉学杂志》2015年第10期989-992,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨围术期纤维支气管镜吸痰对老年肝癌切除术患者术后低氧血症及肺部感染的临床疗效分析。方法选择择期行肝癌切除术的老年男性患者80例,年龄65~75岁,ASAⅡ或Ⅲ级,随机分为两组,每组40例。A组为普通吸痰管吸痰后拔管,B组术中及术后经纤维支气管镜吸痰后拔管。记录患者手术时间、术中出血量、术中输液量、气道压力高值、气道出血、拔管时间,术后24h内低氧血症（SpO2〈90%）、72h内肺部感染情况和术后住院天数。结果术后24h内低氧血症发生率A组（57.5%）明显高于B组（20.0%）（P〈0.05）。肺部感染发生率A组为7.5%,B组无一例肺部感染。A组患者术中气道压力高值、气道出血发生率明显高于、拔管时间明显长于B组[（21.3±6.4）vs.（16.8±3.6）,12例（30.0%）vs.3例（7.5%）,（46.5±8.8）vs.（23.5±4.6）,（P〈0.01）]。A组术后平均住院天数明显长于B组[（12.1±4.4）d vs.（10.6±1.7）d,P〈0.05）]。结论纤维支气管镜吸痰相对于普通吸痰管在围术期的应用,更加有利于老年患者围术期呼吸功能恢复。Objective To evaluate the clinical effect of the application of fiberoptic bronchoscopy on elderly patients with liver cancer during and post operation.Methods Eighty elderly male patients（aged 65-75years）with ASA classⅡorⅢ were randomly allocated into routine group（A,n=40）and bronchoscopy extubation group（B,n=40）.The operation time,intraoperative blood loss and transfusion volume,peak airway pressure,airway bleeding,extubation time,postoperative hypoxemia within 24h（SpO2〈90%）and lung infection within 72 hwere observed and compared.Results Postoperatively,the incidence of hypoxemia in patients within 24 hours was 57.5%（23/40）and 20%（8/40）in group A and B,respectively（P〈0.05）.The peak airway pressure,airway bleeding are higher than group B and extubation time of group A is significantly longer than group B[（21.3±6.4）vs.（16.8±3.6）,12（30.0%）vs.3（7.5%）,（46.5±8.8）vs.（23.5±4.6）,P〈0.01].Compared with group A,the 72 hours lung infection incidence was lower in group B（7.5% vs.0%,P〈0.05）.Moreover,the length of stay in hospital in group A was significantly longer than that in group B[（12.1±4.4）d vs.（10.6±1.7）d,P〈0.05].Conclusion Compared with the classical method of sputum aspiration,fiberoptic bronchoscopy sputum suction is more conducive to elderly patients for perioperative respiratory function recovery.

关 键 词：低氧血症 肝切除术 纤维支气管镜 吸痰 老年患者 

分 类 号：R735.7[医药卫生—肿瘤] R614[医药卫生—临床医学]