肺保护性通气在老年病人腹腔镜肾癌根治术中的应用  

Application of lung protective ventilation in laparoscopic radical nephrectomy in elderly patients

作　　者：朱珊[1] 丁佳慧 张艳梅 徐海飞[1] 张慧[1] 曹汉忠[1] ZHU Shan;DING Jia-hui;ZHANG Yan-mei;XU Hai-fei;ZHANG Hui;CAO Han-zhong(Department of Anesthesia,Nantong Tumor Hospital,Nantong 226000,China)

机构地区：[1]南通市肿瘤医院麻醉科,江苏省南通市226000

出　　处：《实用老年医学》2023年第9期902-906,共5页Practical Geriatrics

基　　金：南通市卫生健康委员会资助项目(QA2020021)。

摘　　要：目的探讨肺保护性通气在老年病人腹腔镜肾癌根治术中的应用效果。方法将2020年10月至2021年10月在本院接受腹腔镜肾癌根治术的原发性肾癌病人106例随机分为对照组、肺保护性通气组,每组各53例。对照组接受全身麻醉及术中常规通气,肺保护性通气组接受全身麻醉及术中肺保护性通气。对比2组的肺顺应性[气道峰压(Ppeak)、气道平台压(Pplat)、氧合指数(PaO_(2)/FiO_(2))、肺动态顺应性(Cdyn)]、血清炎症及氧化应激[IL-6、IL-8、TNF-α、丙二醛(MDA)、超氧化物歧化酶(SOD)]水平、血流动力学相关指标[SBP、DBP、心率(HR)]及术后并发症。结果气腹后2 h、手术结束时,肺保护性通气组的Ppeak、Pplat、IL-6、IL-8、TNF-α、MDA、SBP、DBP和HR水平均低于对照组,SOD、PaO_(2)/FiO_(2)、Cdyn水平高于对照组(均P<0.05)。肺保护性通气组术后并发症总发生率低于对照组(P<0.05)。结论肺保护性通气应用于老年病人腹腔镜肾癌根治术中,有助于改善术中肺顺应性,减轻炎症应激反应,改善血流动力学,减少术后并发症发生率。Objective To investigate the effect of lung protective ventilation in laparoscopic radical nephrectomy in the elderly patients.Methods A total of 106 patients with primary renal cancer who received laparoscopic radical nephrectomy in our hospital from October 2020 to October 2021 were enrolled and randomly divided into the control group and the lung protective ventilation group,with 53 cases in each group.The control group received general anesthesia and routine intraoperative ventilation,while the lung protective ventilation group received general anesthesia and intraoperative lung protective ventilation.Lung compliance[peak pressure(Ppeak),airway plateau pressure(Pplat),oxygenation index(PaO_(2)/FiO_(2)),lung dynamic compliance(Cdyn)],serum inflammation and oxidative stress[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor α(TNF-α),malondialdehyde(MDA),superoxide dismutase(SOD)],hemodynamic indicators[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)]and the incidence of complications between the two groups were compared.Results The levels of Ppeak,Pplat,IL-6,IL-8,TNF-α,MDA,SBP,DBP and HR in lung protective ventilation group were lower than those in control group,while the levels of SOD,PaO_(2)/FiO_(2) and Cdyn levels were higher than those in control group(all P<0.05)2 h after pneumoperitoneum and after surgery.The total incidence rate of the complications in lung protective ventilation group was lower than that in control group(P<0.05).Conclusions The application of lung protective ventilation in laparoscopic radical nephrectomy in elderly patients can improve intraoperative lung compliance,reduce inflammatory stress response,improve hemodynamics and reduce postoperative complications.

关 键 词：肾癌根治术 腹腔镜 肺保护性通气 老年人 肺动态顺应性 并发症 

分 类 号：R737.11[医药卫生—肿瘤]