麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响  

Impact of Different Inspired Oxygen Concentrations during Anesthetic Emergence on Postoperative Atelectasis in Patients Undergoing Laparoscopic Radical Gastrectomy for Gastric Cancer

作　　者：蔡信杰 郭文雅 汪洋[1] 李云[1] CAI Xin-jie;GUO Wen-ya;WANG Yang;LI Yun(Department of Anesthesia and Perioperative Medicine,the Second Afiliated Hospital of Anhui Medical University,Hefei 230601,Anhui,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

出　　处：《广东医学》2024年第2期194-199,共6页Guangdong Medical Journal

基　　金：安徽高校自然科学研究项目(KJ2019ZD24)。

摘　　要：目的探讨麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响。方法选择行择期腹腔镜下胃癌根治术的老年患者68例,随机分为两组:高吸入氧浓度组(C组)和低吸入氧浓度组(L组),每组34例。在麻醉苏醒期间,L组采用40%吸入氧浓度,C组采用100%吸入氧浓度。采用床旁肺超声评估患者12个区域(左肺和右肺各6个区域)的肺超声评分(LUS)。记录入室时(T_(0))、术后30min(T_(4))的LUS评分及术后肺不张的发生率。记录入室(T_(0))、气腹结束时(T_(1))、拔管时(T_(2))、出PACU时(T_(3))的心率(HR)、平均动脉压(MAP),血气分析记录血氧分压(PaO_(2)),计算氧合指数(OI)。记录拔管后在PACU中SpO_(2)<94%事件的发生率。于术前1d(D_(0))和术后1d(D_(1))、3d(D_(2))、5d(D_(3))测定第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、1秒率(FEV_(1)/FVC)。记录术后1d临床肺部感染评分(CPIS)和术后7d肺部并发症的发生情况。结果L组和C组从气腹结束至拔管时间分别为(36.4±5.2)min和(37.3±4.2)min(P>0.05)。与C组相比,L组在T4时的肺超声评分及肺不张发生率明显降低(P<0.05)。L组在T_(3)时,PaO_(2)、OI均明显升高(P<0.05)。在PACU中L组Sp0_(2)<94%事件的发生率低于C组(P<0.05)。与D_(0)时比较,D_(1-3)两组患者的FEV_(1)、FVC、FEV_(1)/FVC均明显降低(P<0.05),与C组比较,L组在D_(1)时FEV_(1)、FVC、FEV_(1)/FVC均明显升高(P<0.05)。术后1dCPIS评分和术后7d肺部并发症发生率两组无明显差异(P>0.05)。结论麻醉苏醒期间低吸入氧浓度能降低老年患者腹腔镜胃癌根治术术后肺不张的发生率及严重程度,改善术后早期肺功能。Objective To investigate the influence of different inspired oxygen concentrations during anesthetic emergence on postoperative atelectasis in elderly patients undergoing elective laparoscopic radical gastrectomy for gastric cancer.Methods Sixty-eight elderly patients scheduled for elective laparoscopic radical gastrectomy were randomly as-signed to either the high inspired oxygen concentration group(Group C)or the low inspired oxygen concentration group(Group L)with 34 patients in each group.During anesthetic emergence,Group L received 40%inspired oxygen,while Group C received 100%inspired oxygen.Bedside lung ultrasound was used to assess lung ultrasound scores(LUS)in 12 regions(6 in each lung)at entry(T_(0))and 30 minutes postoperatively(T_(4)).The occurrence of postoperative atelectasis was recorded.Heart rate(HR),mean arterial pressure(MAP),and blood gas analysis including oxygen partial pressure(PaO_(2))and oxygenation index(OI)were documented at entry(T_(0)),end of pneumoperitoneum(T_(1)),extubation(T_(2)),and PACU discharge(T_(3)).The incidence of SpO_(2)<94%events in the PACU was recorded.Forced expiratory volume in 1 second(FEV_(1)),forced vital capacity(FVC),and FEV_(1)/FVC were measured at preoperative day 1(D_(0))and postop-erative days 1(D_(1)),3(D_(2)),and 5(D_(3)).Clinical Pulmonary Infection Score(CPIS)on postoperative day 1 and the incidence of pulmonary complications on postoperative day 7 were recorded.Results The time from the end of pneumoperitoneum to extubation was comparable between Group L(36.4±5.2 min)and Group C(37.3±4.2 min)(P>0.05).Compared with Group C,Group L showed significantly lower LUS and lower incidence of postoperative atelectasis at T4(P<0.05).At T3,Group L demonstrated significantly increased PaO_(2) and OI(P<0.05).The incidence of Sp0_(2)<94%events in the PACU was lower in Group L than in Group C(P<0.05).Compared with D_(0),FEV^(1),FVC,and FEV_(1)/FVC were significantly reduced in both groups on D_(1-3)(P<0.05).Compared with Group C,Group L showed significantly increased

关 键 词：吸入氧浓度 麻醉苏醒期 肺部超声 老年 胃癌 肺功能 

分 类 号：R614.4[医药卫生—麻醉学] R656.6[医药卫生—外科学]