不同吸入氧浓度对糖尿病合并微血管病变患者围术期肺功能的影响  

Effects of Different Fraction of Inspired Oxygen on Perioperative Lung Function in Patients with Diabetes and Microangiopathy

作　　者：李婷[1] 张亚阳 王建刚 朱健[2] 岳隆基 LI Ting;ZHANG Ya-yang;WANG Jian-gang;ZHU Jian;YUE Long-ji(Department of Anesthesiology,Shanxi Medical University,Taiyuan030001,Shanxi,China;Department of Anesthesiology,First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China;Department of Anesthesiology,Shanxi Provincial People's Hospital,Taiyuan 030012,Shanxi,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]山西医科大学第一医院麻醉科,山西太原030001 [3]山西省人民医院麻醉科,山西太原030012

出　　处：《中国现代手术学杂志》2020年第6期447-452,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的评价机械通气中不同吸入氧浓度(fraction of inspired oxygen,FiO 2)对糖尿病合并微血管病变患者围术期肺功能的影响,为临床提供参考。方法择期行腔镜胃癌根治术的糖尿病合并微血管病变患者60例,采用随机数字表法分为三组(n=20):A组FiO 2为35%,B组为50%,C组为75%。分别于麻醉诱导前(T0)、气腹后30 min(T1)、气腹后60 min(T2)、关气腹后10 min(T3)记录患者生命体征:心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、脉氧饱和度(pulse oxygen saturation,SPO 2),并抽取动脉血行血气分析,计算氧合指数(oxygenation index,OI)、肺内分流率(intrapulmonary shunt rate,Qs/Qt);在手术结束后记录三组患者的达气管拔管指征时间、麻醉恢复室(postanesthesia care unit,PACU)停留时间、术后7 d内肺部并发症(低氧血症、肺炎、呼吸衰竭)发生率。结果与C组比较,A、B组术后达气管拔管指征时间明显较短(P<0.05),A、B组术后达气管拔管指征时间比较差异无统计学意义(P>0.05);在SPO 2水平上,A、B、C三组在T0时比较差异无统计学意义(P>0.05),A组在T1~T3各时间点较B、C组降低(P<0.05),B组在T1~T3各时间点与C组比较差异无统计学意义(P>0.05);与B组比较,A、C组在T1~T3各时间点OI明显降低(P<0.05),A、B、C各组T1~T3时间点OI低于T0时间点(P<0.05);T0时三组Qs/Qt比较差异无统计学意义(P>0.05),与C组比较,A、B组在T1~T3各时间点的Qs/Qt明显减少(P<0.05),A、B、C各组T0时Qs/Qt低于T1~T3(P<0.05)。结论对行腹腔镜胃癌根治术的糖尿病合并微血管病变患者来说,机械通气中吸入50%氧浓度对其围术期肺功能影响较小。Objective To evaluate the effect of different fraction of inspired oxygen(FiO 2)in mechanical ventilation on perioperative lung function in patients with diabetes and microangiopathy.Methods 60 patients with diabetes and microangiopathy undergoing elective laparoscopic radical gastrectomy were divided into 3 groups(n=20)using a random number table method.FiO 2 was 35%of group A,50%of group B and 75%of group C.It was recorded of the vital signs,such as heart rate(HR),systolic pressure(SBP),diastolic pressure(DBP),pulse oxygen saturation(SPO 2)before induction of anesthesia(T0),30 min after pneumoperitoneum(T1),60 min after pneumoperitoneum(T2),and 10 min after the end of pneumoperitoneum(T3).And the oxygenation index of OI(PaO 2/FiO 2),intrapulmonary shunt rate(Qs/Qt)was calculated.At the end of the operation,time duration to reach the indications for tracheal extubation and postoperative period in the postanesthesia care unit(PACU)was recorded.And postoperative 7-day incidence of pulmonary complications(hypoxemia,pneumonia,respiratory failure)was compared too.Results Compared with group C,the duration to reach the indications for tracheal extubation was significantly reduced in group A and B(P<0.05),and there was no statistically significant difference between group A and B(P>0.05).The level of SPO 2 had no statistically significant difference at T0 among the 3 groups(P>0.05),and group A was lower than group C at T1,T2 and T3(P<0.05).There was no significant difference between group B and group C at T1,T2 and T3(P>0.05).Compared with group B,the OI of group A and C at T1,T2 and T3 was significantly lower(P<0.05).In each group,the OI of T1,T2 and T3 was lower than T0(P<0.05).There was no statistical significance in Qs/Qt among the three groups at T0(P>0.05).But compared with group C,the Qs/Qt of group A and B was lower at T1,T2 and T3(P<0.05).In the intra-group comparison,Qs/Qt at T0 was lower than that of T1~T3(P<0.05).Conclusion For patients with diabetes and microangiopathy undergoing laparoscopic radical gastr

关 键 词：吸入氧浓度 糖尿病 肺功能 氧合指数 肺内分流率 

分 类 号：R614.2[医药卫生—麻醉学]