帕瑞昔布联合不同通气模式对后腹膜腔镜手术老年患者的肺保护作用  

Lung protection effects of parecoxib combined with different ventilation mode in elderly patients undergoing retroperitoneal laparoscopic surgery

作　　者：郝玉娟 王胜斌[2] 张野[1] HAO Yu-juan;WANG Sheng-bin;ZHANG Ye(Department of Anesthesia and Perioperative Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei ANHUI 230601,China;Department of Anesthesiology,the Anqing Hospital Affiliated to Anhui Medical University,Anqing ANHUI 246003,China)

机构地区：[1]安徽医科大学第二附属医院麻醉与围术期医学科,安徽合肥230601 [2]安徽医科大学附属安庆医院麻醉科,安徽安庆246003

出　　处：《中国新药与临床杂志》2022年第6期352-356,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：安徽省面上科技攻关项目(1704a0802165)。

摘　　要：目的观察帕瑞昔布联合不同通气模式对经后腹膜腔镜手术老年患者的肺保护作用。方法选择择期行经后腹膜腔镜手术的老年患者140例,随机分为容量控制通气模式组(V组)、压力控制容量保证(PCV-VG)通气模式组(P组)、帕瑞昔布联合容量控制通气模式组(VR组)、帕瑞昔布联合PCV-VG通气模式组(PR组),每组35例。VR组及PR组麻醉诱导前10 min给予帕瑞昔布40 mg静脉注射。麻醉诱导后行气管插管,连接麻醉机行机械通气。观察并记录气道峰压(P_(peak))、气道平均压(P_(mean))、动态肺顺应性(C_(dyn)),并根据血pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))计算肺泡-动脉血氧分压差(P_(A-a)O_(2))、氧合指数(OI)。检测患者血白细胞介素(IL)-6和肿瘤坏死因子(TNF)-α水平,并记录术后7 d内肺部并发症的发生情况。结果与V组相比,气管插管后5 min(T_(1)),改变体位后5 min(T_(2)),气腹后10 min(T_(3))、60 min(T_(4))、120 min(T_(5))和气腹结束且恢复平卧位后10 min(T_(6))时P组及PR组的P_(peak)下降,P_(mean)、C_(dyn)升高(P<0.05),且各观察时点PR组P_(peak)低于P组和VR组,P_(mean)、C_(dyn)高于P组和VR组,均有显著差异(P<0.05)。与V组相比,T_(1)、T_(4)、T_(6)时VR组和PR组P_(A-a)O_(2)降低,OI升高(P<0.05),且PR组各时点P_(A-a)O_(2)低于P组和VR组,OI高于P组和VR组,差异均有显著意义(P<0.05)。与V组相比,其他三组术毕即刻及术后24 h血清IL-6和TNF-α浓度均下降(P<0.05),且PR组IL-6和TNF-α浓度低于P组和VR组(P<0.05)。V组出现肺部感染1例,肺不张1例,其他组无肺部并发症发生。结论帕瑞昔布联合PCV-VG通气模式对经后腹膜腔镜手术老年患者有一定的肺保护作用。AIM To observe the effects of parecoxib combined with different ventilation mode on lung protection in elderly patients undergoing retroperitoneal laparoscopic surgery.METHODS One hundred and forty aged patients,scheduled for elective retroperitoneal laparoscopy,were randomly divided into 4 groups(n=35 each):volume-controlled ventilation group(group V),pressure-controlled ventilation-volume guaranteed(PCV-VG)ventilation group(group P),parecoxib combined with volume-controlled ventilation group(group VR),parecoxib combined with PCV-VG ventilation group(group PR).Group VR and group PR were given parecoxib 40 mg intravenously 10 min before induction of anesthesia.After anesthesia induction,endotracheal intubation was performed,and mechanical ventilation was performed by connecting anesthesia machine.Airway peak pressure(P_(peak)),mean airway pressure(P_(mean)),and lung dynamic compliance(C_(dyn))were recorded.The radial artery blood samples were collected and pH,PaO_(2) and PaCO_(2) were recorded and lung function indexes including P_(A-a)O_(2) and OI were calculated.The radial artery blood samples were collected for determination of inflammatory factors interleukin(IL)-6 and tumor necrosis factor(TNF)-α.The pulmonary complications within 7 days after surgery were recorded.RESULTS Compared with group V,P_(peak) was decreased,P_(mean) and C_(dyn) were increased significantly at 5 min after endotracheal intubation(T_(1)),at 5 min after changing body position(T_(2)),at 10 min(T_(3)),60 min(T_(4)),120 min(T_(5))after establishing pneumoperitoneum,and at 10 min after both closing pneumoperitoneum and the change of supine position(T_(6))in group P and group PR(P<0.05).P_(peak) was lower at every time point,P_(mean) and C_(dyn) were higher in group PR than those in group P and group VR,the difference were statistically significant(P<0.05).Compared with group V,P_(A-a)O_(2) was decreased significantly at T_(1),T_(4),T_(6),and OI was increased in group R and group PR(P<0.05).P_(A-a)O_(2) was lower at every time point,and OI

关 键 词：帕瑞昔布 腹腔镜 通气机 机械 老年人 麻醉 肺保护 经后腹膜腔镜 

分 类 号：R971[医药卫生—药品]