体外膈肌起搏预防老年腹部手术后肺部并发症的初步研究  

Extracorporeal diaphragm pacing for pulmonary complications after abdominal surgery in elderly patients:A preliminary study

作　　者：梁致如[1] 付玲霞[1] 任杰 王元 桂寿 张培城 王松 刘朝阳[1] LIANG Zhiru;FU Lingxia;REN Jie;WANG Yuan;GUI Shou;ZHANG Peicheng;WANG Song;LIU Chaoyang(Department of General Surgery,the Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Wuhu No.1 Cadre’s Sanitarium of Anhui Military Command,Wuhu 241000,Anhui Province,China;Haidian No.23 Cadre’s Sanitarium of Beijing Garrison Command,Beijing 100039,China;Haidian No.20 Cadre’s Sanitarium of Beijing Garrison Command,Beijing 100090,China;Haidian No.51 Cadre’s Sanitarium of Beijing Garrison Command,Beijing 100142,China;Xicheng No.1 Cadre’s Sanitarium of Beijing Garrison Command,Beijing 100031,China)

机构地区：[1]解放军总医院第二医学中心综合外科,北京100853 [2]安徽省军区芜湖第一离职干部休养所,安徽芜湖241000 [3]北京卫戍区海淀第二十三离职干部休养所,北京100039 [4]北京卫戍区海淀第二十退休干部休养所,北京100090 [5]北京卫戍区海淀第五十一离职干部休养所,100142 [6]北京卫戍区西城第一退休干部休养所,北京100031

出　　处：《解放军医学院学报》2021年第8期823-828,共6页Academic Journal of Chinese PLA Medical School

摘　　要：背景老年腹部手术术后肺部并发症(postoperative pulmonary complications,PPCs)是术后常见并发症和重要死因,防治PPCs是保障老年腹部手术患者术后安全的重要环节,但简单有效的治疗方法很少。目的观察体外膈肌起搏预防老年腹部手术后肺部并发症的效果。方法纳入解放军总医院第二医学中心综合外科重症监护室51例年龄≥65岁全麻腹部手术患者,随机分为试验组(EDP组)26例(术后采用体外膈肌起搏器治疗,2次/d,30 min/次)和对照组(Vest TM组)25例(术后采用VEST气道清除系统治疗,2次/d,15 min/次)。两组均由术后第1天开始连续治疗5 d。通过对比两组术后肺部并发症、肺功能、血气分析、经皮血氧饱和度、排痰量、切口疼痛评分,评价体外膈肌起搏预防老年腹部术后肺部并发症的效果。结果两组术后肺功能指标均有所下降,EDP组术后肺功能指标用力肺活量(forced vital capacity,FVC)[(2.75±0.51)L vs(2.45±0.48)L]、一秒量(forced expiratory volume in one second,FEV1)[(1.98±0.53)L/s vs(1.69±0.29)L/s]、一秒率(FEV1/FVC)(72.6±8.72 vs 66.45±9.83)以及治疗中经皮血氧饱和度(95%±5%vs 90%±6%)均显著高于Vest TM组,术后第3天起VAS评分(第3天:2.8±0.9 vs 3.6±1.7;第5天:1.0±0.7 vs 1.8±0.8)显著低于Vest TM组,以上指标差异均有统计学意义(P<0.05)。EDP组术后肺部并发症总发生率(15.38%vs 28%)、术后各并发症发生率(肺不张7.69%vs 16.00%,肺部感染3.85%vs 8.00%,呼吸衰竭3.85%vs 4.00%,再插管机械通气0 vs 4.00%)、术后PCO_(2)[第1天:(45.81±3.97)mmHg vs(46.73±4.24)mmHg;第3天:(42.27±3.64)mmHg vs(42.96±3.82)mmHg;第5天:(41.64±4.15)vs(41.93±3.75)mmHg]、术后排痰量[第1天:(14.5±4.6)mL vs(16.7±5.3)mL;第3天:(18.3±7.8)mL vs(20.8±6.5)mL;第5天:(6.1±2.4)mL vs(7.4±3.3)mL]均低于Vest TM组,术后PO_(2)[第1天:(72.67±11.31)mmHg vs(69.23±10.56)mmHg;第3天:(77.82±12.24)mmHg vs(74.42±11.17)mmHg;第5天:(77.93±11.78)mmHg vs(75.15±12.60)Background Postoperative pulmonary complications(PPCs)is a common and important cause of death in elderly patients undergoing abdominal surgery.Prevention and treatment of PPCs is of great importance to ensure the postoperative safety.But there are few proved simple and effective treatments.Objective To observe the effect of extracorporeal diaphragm pacing(EDP)on preventing pulmonary complications after abdominal surgery in the elderly.Methods Fifty-one elderly patients undergoing abdominal surgery in the Second Medical Center of Chinese PLA General Hospital were randomly divided into experimental group(EDP group),26 of whom were treated with external diaphragm pacemaker after operation,twice per day,30 min for each time.Patients in the control group(Vest TM group,n=25)were treated with VEST airway clearance system after operation,twice per day,15 min for each time.The treatment began at the first day after operation and lasted for 5 days.By comparing the postoperative pulmonary complications,pulmonary function,arterial blood gas analysis,percutaneous blood saturation,sputum excretion and incision pain score,the effect of EDP on preventing pulmonary complications after abdominal operation in elderly patients was evaluated.Results The pulmonary function indexes of the two groups decreased after surgery.Compared with the control group,the indexes of pulmonary function in the EDP group including forced vital capacity(FVC)(L)(2.75±0.51 vs 2.45±0.48),forced expiratory volume in one second(FEV1)(L/s)(1.98±0.53 vs 1.69±0.29),FEV1/FVC(72.6±8.72 vs 66.45±9.83)and transdermal blood oxygen saturation(95%±5%vs 90%±6%)were significantly higher than those in the Vest TM group(all P<0.05).VAS score on the 3^(rd)(2.8±0.9 vs 3.6±1.7,P<0.05)and the 5th day(1.0±0.7 vs 1.8±0.8,P<0.05)after surgery were significantly lower than those of the control group(P<0.05,respectively).The incidence of postoperative pulmonary complications(total complications:15.38%vs 28%,atelectasis:7.69%%vs 16%,pulmonary infection:3.85%vs 8%,respi

关 键 词：体外膈肌起搏器 术后肺部并发症 老年 腹部手术 肺功能 

分 类 号：R605[医药卫生—外科学]