不同持续时长过度通气对老年结直肠癌全身麻醉腹腔镜手术患者术后血流动力学指标及呼吸功能的影响  

Effects of different durations of hyperventilation on postoperative hemodynamic indexes and respiratory function in elderly patients with colorectal cancer undergoing laparoscopic surgery under general anesthesia

作　　者：李玲霞[1] 高东梅[2] 胡彬 贺芬[4] 任斐[1] 王敏[1] 李元军[5] LI Ling-xia;GAO Dong-mei;HU Bin(Department of Anesthesiology,Affiliated Hospital of Yan'an University,Yan'an Shaanxi 716000,China;Department of Pain Rehabilitation Medicine,Affiliated Hospital of Yan'an University,Yan'an Shaanxi 716000,China;Department of Anesthesiology,Xi'an International Medical High-tech Hospital,Xi'an Shaanxi 710000,China)

机构地区：[1]延安大学附属医院麻醉科,陕西延安716000 [2]延安大学附属医院痛康复医学科,陕西延安716000 [3]西安国际医学高新医院麻醉科,陕西西安710000 [4]延安大学附属医院重症医学科,陕西延安716000 [5]延安大学附属医院呼吸内科,陕西延安716000

出　　处：《临床和实验医学杂志》2021年第20期2218-2222,共5页Journal of Clinical and Experimental Medicine

基　　金：陕西省社会发展科技攻关项目(编号:2016SF-075);延安市科技计划项目(编号:SL2019ZCSY-002);延安市科技计划项目(编号:SL2019ZCSZ-003)。

摘　　要：目的探讨不同持续时长过度通气对老年结直肠癌全身麻醉腹腔镜手术患者术后血流动力学指标及呼吸功能的影响。方法回顾性选取2019年8月至2021年1月延安大学附属医院收治的120例结直肠癌患者作为研究对象,根据通气设置不同将所有患者分为3组,即试验1组、试验2组和对照组,每组40例。所有患者均行全身麻醉腹腔镜手术,对每组分别应用不同持续时间过度通气,对照组f:12次/min,I∶E:1∶2,术中根据呼末二氧化碳分压(PETCO_(2))进行调整,维持PETCO_(2)在35~45 mmHg;试验1组在插管后f:12次/min,气腹时f:15~20次/min,持续到术毕;试验2组在插管后f:12次/min,气腹时f:15~20次/min,持续自主呼吸恢复。比较3组患者术后睁眼时间、自主呼吸恢复时间、拔管时间以及离开PACU时间,比较3组患者插管后5 min、气腹后30 min和手术结束血流动力学[平均动脉压(MAP)、心率、心脏指数(CI)、每搏指数(SVI)、每搏变异度(SVV)]与呼吸功能[PETCO_(2)、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]指标,并比较3组患者的不良反应情况。结果试验2组与试验1组睁眼时间、拔管时间比较,差异无统计学意义(P>0.05);试验2组患者睁眼时间、自主呼吸恢复时间、拔管时间、PACU停留时间显著低于试验1组与对照组,差异均有统计学意义(P<0.05)。气腹后30 min,3组患者SVV、CI比较,差异无统计学意义(P>0.05),试验2组SVI、MAP、心率明显高于试验1组与对照组,差异均有统计学意义(P<0.05);手术结束即刻,3组患者的SVV、SVI比较,差异无统计学意义(P>0.05),试验2组CI、MAP、心率高于试验1组与对照组,差异均有统计学意义(P<0.05)。气腹后30 min和手术结束即刻,试验2组PETCO_(2)水平明显高于试验1组与对照组,PaCO_(2)水平明显低于试验1组与对照组,差异均有统计学意义(P<0.05)。试验2组患者术后躁动、恶心呕吐、呼吸抑制、谵妄等不良反应发生Objective To explore the effects of different duration of hyperventilation on postoperative hemodynamic indexes and respiratory function in elderly patients with colorectal cancer undergoing laparoscopic surgery under general anesthesia.Methods A total of 120 patients with colorectal cancer admitted to Affiliated Hospital of Yan'an University from August 2019 to January 2021 were retrospectively selected as the research objects,and all patients were divided into three groups according to different ventilation settings,namely experimental group 1,experimental group 2,and control group,40 cases in each group.In the control group,f:12 times/min,I∶E:1∶2,partial pressure of end-tidal carbon dioxide(PETCO_(2))was adjusted to maintain PETCO_(2) at 35-45 mmHg;in group 1,f:12 times/min after intubation and f:15-20 times/min during pneumoperitoneum,which lasted until the end of operation;after intubation,f:12 times/min,during pneumoperitoneum,f:15-20 times/min,continuous spontaneous breathing recovery.The time of opening eyes,recovery time of spontaneous breathing,extubation time and time of leaving PACU were compared among the three groups.The indexes of hemodynamics[mean arterial pressure(MAP),heart rate,cardiac index(CI),stroke index(SVI),stroke variability(SVV)and respiratory function[PETCO_(2),arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2))]were compared among the three groups 5 minutes after intubation,30 minutes after pneumoperitoneum and immediately after operation,and the adverse reactions of the three groups were compared.Results There was no significant difference in eye opening time and extubation time between group 2 and group 1(P>0.05),the eye-opening time,spontaneous breathing recovery time,extubation time,and PACU stay time of the experimental group 2 patients were significantly lower than those of the experimental group 1 and the control group,and the differences were statistically significant(P<0.05).There was no significant difference in SVV and CI a

关 键 词：过度通气 持续时间 结直肠癌 苏醒质量 呼吸力学 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]