非通气侧肺持续中低流量给氧在老年胸腔镜肺癌根治术中的应用  

Application of continuous medium and low flow oxygen supply to non-ventilated lung in elderly thoracoscopic radical resection of lung cancer

作　　者：黄俊萍 周颖[2] 闭玉华 HUANG Jun-ping;ZHOU Ying;BI Yu-hua(Department of Anesthesiology and Surgery,Wuming Hospital of Guangxi Medical University,Nanning Guangxi 530199,China;Department of Anesthesiology,Yulin Red Cross Hospital,Yulin Guangxi 537000,China)

机构地区：[1]广西医科大学附属武鸣医院麻醉手术科,广西南宁530199 [2]玉林市红十字会医院麻醉科,广西玉林537000

出　　处：《局解手术学杂志》2023年第3期262-265,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：广西壮族自治区卫生健康委自筹课题(Z20210428)。

摘　　要：目的探讨非通气侧肺持续中低流量给氧在老年胸腔镜肺癌根治术中的临床应用效果。方法选择广西医科大学附属武鸣医院接受胸腔镜治疗的老年肺癌患者80例,按照随机数字表法将其分为观察组和对照组,每组40例。观察组单肺通气过程中非通气侧肺持续中低流量给氧,对照组非通气侧肺未进行特殊给氧。比较2组单肺通气过程中丙二醛(MDA)、超氧化物歧化酶(SOD)、超敏C反应蛋白(hs-CRP)等氧化应激与炎症指标。比较2组麻醉前、单肺通气时、干预15 min时、给氧干预1 h时及停止单肺通气时动脉血氧分压变化情况。比较2组单肺通气过程中气道平台压(Pplat)、气道峰压(Ppeak)及肺顺应性Cldyn20水平。统计2组麻醉苏醒相关指标和围术期呼吸相关并发症发生情况。结果单肺通气过程中,观察组SOD水平高于对照组(P<0.05),MDA、hs-CRP水平低于对照组(P<0.05),观察组干预15 min时、给氧干预1 h时及停止单肺通气时动脉血氧分压均高于对照组(P<0.05)。单肺通气过程中观察组Pplat、Ppeak低于对照组(P<0.05),Cldyn20水平高于对照组(P<0.05)。观察组呼吸恢复时间、意识恢复时间、拔管时间和复苏室停留总时间均显著短于对照组(P<0.05),肺不张、低氧血症、气胸和复张性肺水肿等围术期呼吸相关并发症的总发生率显著低于对照组(P<0.05)。结论老年胸腔镜肺癌根治术患者实施非通气侧肺组织持续中低流量给氧,能有效降低机体炎症应激反应,增加动脉血氧分压,改善肺通气功能与顺应性,促进麻醉复苏,且可显著减少呼吸相关并发症的发生。Objective To explore the clinical application effect of continuous medium and low flow oxygen supply to non-ventilated lung in elder patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 80 elderly patients with lung cancer treated by thoracoscopy in Wuming Hospital of Guangxi Medical University were selected and divided into the observation group and the control group according to the random number table method,with 40 cases in each group.Patients in the observation group were given continuous medium and low flow oxygen supply to non-ventilated lung during one-lung ventilation,while no special oxygen was given to the non-ventilated lung for patients in the control group.The levels of oxidative stress and inflammatory indexes such as malondialdehyde(MDA),superoxide dismutase(SOD)and hypersensitivity-C reactive protein(hs-CRP)during one-lung ventilation between the two groups were compared.The changes of arterial oxygen partial pressure before anesthesia,during one-lung ventilation,after intervention for 15 minutes,after giving oxygen intervention for 1 hour and after stopping one-lung ventilation between the two groups were compared.The airway plateau pressure(Pplat),peak pressure(Ppeak)and lung compliance Cldyn20 level during one-lung ventilation between the two groups were compared.The related indexes of anesthesia recovery and the occurrence of perioperative respiration related complications between the two groups were counted.Results During one-lung ventilation,the SOD level of the observation group was higher than that of the control group(P<0.05),the levels of MDA and hs-CRP were lower than those in the control group(P<0.05).The arterial oxygen partial pressures after intervention for 15 minutes,after giving oxygen intervention for 1 hour and after stopping one-lung ventilation in the observation group were higher than those in the control group(P<0.05).During one-lung ventilation,the Pplat and Ppeak of the observation group were lower than those of the control group(P<0.05),

关 键 词：非通气侧肺 持续中低流量给氧 单肺通气 胸腔镜 肺癌根治术 

分 类 号：R734.2[医药卫生—肿瘤]