允许性高碳酸血症对食管癌胸腹腔镜联合手术患者围手术期肺部反应的影响  

Effect of permissive hypercapnia on perioperative pulmonary inflammatory response in patients undergoing thoracoscopic combined with laparoscopic esophagectomy

作　　者：陆宇海 贾维坤[1] 曾小飞[1] 何小平[1] 王洪 马瑞东[1] Lu Yuhai;Jia Weikun;Zeng Xiaofei;He Xiaoping;Wang Hong;Ma Ruidong(Department of Thoracic and Cardiovascular Surgery,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610000,China)

机构地区：[1]成都医学院第一附属医院胸心外科,610000

出　　处：《中华内分泌外科杂志》2021年第6期618-621,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的研究允许性高碳酸血症对胸腹腔镜联合食管癌手术患者肺部反应的影响。方法选择2018年1月至2020年1月于成都医学院第一附属医院行胸腹腔镜联合食管癌根治术患者90例,采用随机数字表法平均分为三组,观察组A维持术中二氧化碳分压(partial pressure of carbon dioxide,PaCO2)在56~65 mmHg(1 mm Hg=0.133 kPa)范围内,观察组B维持术中PaCO2在46~55 mmHg范围内,对照组维持术中PaCO2在35~45 mmHg范围,观察比较插管后(T1)、右侧气胸后30min(T2)、右肺复张后30min(T3)的气道峰压、动态肺顺应性、氧合指数;分析并比较术后第1、4、7天临床肺部感染评分(clinical pulmonary infection score,CPIS)、血清降钙素原(PCT)。结果观察组A在T2时较观察组B及对照组动态肺顺应性最高(25.13±5.70 vs 22.28±4.26 vs 19.99±4.36),心率最快(102.04±10.91 vs 96.46±9.91 vs 92.28±8.08),气道压最低(17.62±1.79 vs 18.96±1.90 vs 20.39±1.71)(P<0.05);观察组A较观察组B及对照组术后第1天、4天、7天CPIS均最低(1.12±0.77 vs 1.71±0.90 vs 2.64±1.07)(6.08±1.20 vs 7.43±1.10 vs 8.31±1.55)(1.69±1.12 vs 2.32±0.98 vs 3.44±1.25)(P<0.05)。结论允许性高碳酸血症能降低气道阻力,提高肺顺应性,并能减轻术后肺部感染。Objective To study the effect of permissive hypercapnia on pulmonary infection in patients underwent thoracoscopic combined with laparoscopic radical esophagectomy.Methods From 2018 to 2020,90 who patients underwent thoracoscopic laparoscopy combined with radical esophagectomy were divided into 3 groups by random who number table method,including 30 patients in experimental group 1,30 patients in experimental group 2,and 30 patients in control group.PaCO2 was maintained in the range of 56 mmHg-65 mmHg in experimental group 1,46 mmHg-55 mmHg in experimental group 2 and 35 mmHg-45 mmHg in control group.The peak airway pressure(Ppeak),lung dynamic compliance(Cdyn)and oxygenation index(OI)were observed and compared among the three groups after endotracheal intubation(T1),30 min after right artificial pneumothorax(T2)and 30 min after right lung recruitment(T3);The clinical pulmonary infection score(CPIS),serum procalcitonin(PCT)on the 1st,4th and 7th day after operation were analyzed and compared.Results At T2,observation group A had the highest dynamic lung compliance(25.13±5.70 vs 22.28±4.26 vs 19.99±4.36),the fastest heart rate(102.04±10.91 vs 96.46±9.91 vs 92.28±8.08)and the lowest airway pressure(17.62±1.79 vs 18.96±1.90 vs 20.39±1.71)(P<0.05).Observation group A had the lowest CPIS on the 1st,4th and 7th day after operation compared with observation group B and control group(1.12±0.77 vs 1.71±0.90 vs 2.64±1.07)(6.08±1.20 vs 7.43±1.10 vs 8.31±1.55)(1.69±1.12 vs 2.32±0.98 vs 3.44±1.25)(P<0.05).Conclusion Permissive hypercapnia can reduce airway resistance,improve lung compliance and reduce the risk of postoperative pulmonary infection.

关 键 词：允许性高碳酸血症 气道压 动态肺顺应性 肺部感染 

分 类 号：R322.4[医药卫生—人体解剖和组织胚胎学]