呼吸肌锻炼联合保护性肺通气对机器人辅助前列腺癌根治术老年患者肺不张的影响  

Effect of respiratory muscle exercise combined with lung protective ventilation strategy on atelectasis of elderly patients with robot-assisted radical prostatectomy

作　　者：武晓丽[1] 聂丽霞[1] 苏学森 胡珊 田首元[1] Wu Xiaoli;Nie Lixia;Su Xuesen;Hu Shan;Tian Shouyuan(Department of Anesthesiology,First Hospital of Shanxi Medical University,Taiyuan,030001,China)

机构地区：[1]山西医科大学第一医院麻醉科,太原030001

出　　处：《中华老年医学杂志》2021年第10期1304-1308,共5页Chinese Journal of Geriatrics

基　　金：山西医科大学第一医院院级基金(YD1608,YJ161709)。

摘　　要：目的探讨术前呼吸肌功能锻炼联合术中肺保护性通气策略对机器人辅助前列腺癌根治术老年患者肺不张的影响。方法前瞻性研究,入选山西医科大学第一医院泌尿科择期行机器人辅助前列腺癌根治术患者45例,年龄65~80岁。采用随机数字表法分为呼吸肌功能锻炼联合肺保护性通气策略组(联合组)、肺保护性通气策略组(肺保护组)及传统通气策略的对照组,各15例。3组患者分别于进入手术室后建立有创动脉即刻、气管插管后10 min、屈氏体位后1 h、气管拔管后30 min、术后24 h记录心率、收缩压、舒张压、氧饱和度并采集动脉血标本行血气分析,计算氧合指数。于气管插管后10 min、屈氏体位后1 h及气管拔管后30 min记录肺顺应性值、气道峰压及呼气末二氧化碳。术后1 h(满足麻醉苏醒steward评分≥5分)进行单层胸部CT扫描,计算肺不张面积百分比。结果联合组、肺保护组和对照组患者美国麻醉师协会(ASA)分级Ⅱ、Ⅲ级分别为11、4、12、3、11、4例,差异无统计学意义(χ^(2)=0.127,P>0.05)。与肺保护组患者比较,联合组术后24 h时氧合指数较高,(337.0±13.4)mmHg比(351.1±11.2)mmHg(1 mmHg=0.133 kPa),差异有统计学意义(t=3.287,P<0.05)。气管拔管后30 min时,联合组、肺保护组患者与对照组比较,CT评估肺不张面积较小,中位数(四分位数间距)分别为1.92(0.77)%、2.09(1.13)%比3.01(1.01)%,差异有统计学意义(H值分别为26.036、12.313,均P<0.05);气管拔管后30 min时,联合组较肺保护组患者肺不张面积小(Z=6.240,P<0.05)。结论术前呼吸肌锻炼联合术中肺保护性通气策略能够更好地达到肺保护的效果,降低老年机器人辅助前列腺癌根治术患者围术期肺不张程度,改善氧合功能。Objective To evaluate the effect of preoperative respiratory muscle exercise combined with intraoperative lung protective ventilation strategy on atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.Methods In the prospective study,a total of 45 patients aged 65-80 years undergoing scheduled robot-assisted radical prostatectomy in First Hospital of Shanxi Medical University from August 2020 to November 2020 were divided into three groups(N=15,each):respiratory muscle exercise combined with lung protective ventilation strategy group(combined group),lung protective ventilation strategy group(pulmonary protective group)and conventional ventilation strategy(control group).Heart rate,systolic blood pressure,diastolic pressure,and pulse oxygen saturation as well as blood gas analysis of arterial blood and the calculated oxygenation index were measured and recorded immediately after establishing invasive artery monitoring in operating room,10 min after endotracheal intubation,1 h after the flexitic position,30 min after tracheal extubation,24 h after operation in all three groups of patients.The lung compliance values,peak airway pressure,and end-tidal carbon dioxide were recorded at 10 minutes after tracheal intubation,30 minutes after tracheal extubation,1 hour after succession position.A single-slice chest CT scan was performed at 1 h after surgery while satisfying the anesthesia recovery steward score≥5.And the percentage of atelectasis area was calculated.Results The American Society of Anesthesiologisits(ASA)classification of patients was 11/4,12/3,and 11/4 in the combination group,lung protection group and control group respectively,and the difference was not statistically significant(χ^(2)=0.127,P>0.05).Oxygenation index(mmHg)(1 mmHg=0.133 kPa)at 24 h after surgery was significantly higher in the combined group(351.1±11.2)than in lung protection group(337.0±13.4)(t=3.287,P<0.05).Atelectasis area(Median,Interquartile range)assessed by CT imaging at 30 min after tracheal extubation

关 键 词：呼吸锻炼 肺通气 肺不张 前列腺肿瘤 

分 类 号：R737.25[医药卫生—肿瘤]