个体化肺复张策略对老年腹腔镜胃癌手术患者术后肺部并发症的影响  

Effect of individualized lung re⁃expansion strategy on postoperative pulmonary complications in elderly patients undergoing laparoscopic gastric cancer surgery

作　　者：喇宏玲 马琳 苏涛[1] 徐桂萍[1] La Hongling;Ma Lin;Su Tao;Xu Guiping(Department of Anesthesiology,People's Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Clinical Research Center for Anesthesia Management,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,新疆麻醉管理临床医学研究中心,乌鲁木齐830001

出　　处：《国际麻醉学与复苏杂志》2023年第3期273-278,共6页International Journal of Anesthesiology and Resuscitation

基　　金：新疆维吾尔自治区人民医院院内项目(20200312)。

摘　　要：目的探讨肺部超声指导肺复张与传统肺复张对老年腹腔镜胃癌手术患者术后肺部并发症的影响。方法选择2022年3月至2022年6月择期行腹腔镜胃癌手术的老年患者80例,男42例,女38例,年龄≥65岁,BMI 18~30 kg/m2,ASA分级Ⅰ~Ⅲ级,采用随机数字表法将患者分为两组:传统肺复张组(R组)和肺部超声指导肺复张组(LUS⁃R组),每组40例。记录入手术室时(T1)、全麻拔管后30 min(T2)、术后24 h(T3)、术后48 h(T4)的肺部超声检查评分(lung ultrasound score,LUS);采集静脉血,ELISA法检测血清克拉拉细胞分泌蛋白(clara cell secretory proteins,CC16)水平;取桡动脉血行血气分析,计算氧合指数(oxygen index,OI);计算插管后10 min(t1)、手术结束前10 min(t2)的动态肺顺应性(dynamic lung compliance,C_(dyn));记录肺复张总次数,肺复张总时长,肺复张时血压下降幅度超过术前20%的次数,手术时间,气管插管拔管时间(手术结束至气管插管拔管的时间),液体出入量,术后第2天、术后第5天术后肺部并发症(postoperative pulmonary complication,PPC)发生率。结果两组患者T2、T3时LUS较T1时均升高(P<0.05)。R组中,T4时LUS较T1升高(P<0.05);LUS⁃R组中,T4时LUS与T1时比较差异无统计学意义(P>0.05)。与R组比较,LUS⁃R组T2~T4时LUS均降低(P<0.05)。两组患者T2、T3时OI较T1时均降低(P<0.05),T4时与T1时比较差异无统计学意义(P>0.05)。与R组比较,LUS⁃R组T2、T3、T4时OI均增加(P<0.05)。两组患者t2时较t1时C_(dyn)均降低(P<0.05)。与R组比较,LUS⁃R组t2时C_(dyn)增加(P<0.05)。两组患者T2~T4时血清CC16水平较T1时均升高(P<0.05)。与R组比较,LUS⁃R组T2~T4时CC16水平均低(P<0.05)。LUS⁃R组的肺复张总时长及肺复张时血压下降幅度超过术前20%的次数较R组少(P<0.05)。两组患者肺复张总次数、手术时间、气管插管拔管时间、液体出入量比较,差异无统计学意义(P>0.05)。术后第2天、术后第5天两组PPC发生率比较,�Objective To investigate the effect of pulmonary ultrasound⁃guided lung re⁃expansion versus conventional lung re⁃expansion on postoperative pulmonary complications in elderly patients undergoing laparoscopic gastric cancer surgery.Meth⁃ods A total of 80 elderly patients,42 men and 38 women,aged≥65 years,BMI 18−30 kg/m2,ASA classification gradeⅠ−Ⅲ,who un⁃derwent elective laparoscopic gastric cancer surgery from March 2022 to June 2022 were selected.According to the random number ta⁃ble method,they were divided into two groups(n=40):a conventional lung resuscitation group(group R)and a pulmonary ultrasound⁃guided lung re⁃expansion group(group LUS⁃R).The lung ultrasound score(LUS)was recorded before the patients entered the operating room(T1),30 min after extubation at the end of anesthesia(T2),and at postoperative 24 h(T3)and 48 h(T4).Venous blood samples were collected to measure the levels of serum clara cell secretory proteins(CC16).The radial artery blood samples were taken for blood gas analysis to calculate the oxygen index(OI).Dynamic lung compliance(C_(dyn))was calculated 10 min after intubation(t1)and 10 min before the end of surgery(t2).The total number of lung re⁃expansion,the entire duration of lung re⁃expansion,the num⁃ber of lung re⁃expansion in which the blood pressure dropped by more than 20%compared with that in the preoperative period,the time of operation,the time of endotracheal extubation(from the end of operation to endotracheal extubation),the fluid intake and out⁃put,and the incidence of postoperative pulmonary complication(PPC)on postoperative day two and postoperative day five were record⁃ed.Results Patients in both groups showed elevated LUS at T2−T3 compared with those at T1(P<0.05).In group R,LUS was ele⁃vated at T4 compared with that at T1(P<0.05).In group LUS⁃R,no statistical difference was found in LUS between T4 and T1(P>0.05).Compared with group R,group LUS showed decreases in LUS at T2−T4(P<0.05).Patients in both groups presented red

关 键 词：肺 超声监测 肺复张 老年人 肺部并发症 

分 类 号：R735.2[医药卫生—肿瘤]