不同吸入氧浓度对老年患者腹腔镜前列腺癌根治术后早期肺功能的影响  

Effect of different fraction of inspiration oxygen on early pulmonary function after laparoscopic radical prostatectomy for prostate cancer in elderly patients

作　　者：汪洋[1] 郭文雅 蔡信杰 张野[1] 李云[1] WANG Yang;GUO Wenya;CAI Xinjie;ZHANG Ye;LI Yun(Department of Anesthesiology and Perioperative Medicine,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,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,合肥市230601

出　　处：《临床麻醉学杂志》2024年第5期482-487,共6页Journal of Clinical Anesthesiology

基　　金：安徽高校自然科学研究项目(KJ2019ZD24);安徽省转化医学研究院科研基金(2020zhyx-A06)。

摘　　要：目的比较术中吸入氧浓度(FiO_(2))30%和80%对老年患者腹腔镜前列腺癌根治术后肺功能的影响。方法选择择期行腹腔镜前列腺癌根治术的老年患者60例,年龄≥65岁,BMI 18~30 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:FiO_(2)30%组(L组)和FiO_(2)80%组(H组),每组30例。气管插管后行肺复张,L组调整FiO_(2)为30%直至拔除气管导管。H组调整FiO_(2)为80%直至拔除气管导管。记录入室后5 min(T_(0))、手术开始后1 h(T_(1))、手术开始后2 h(T_(2))、拔管后30 min(T_(3))的HR、MAP,并行动脉血气分析记录PaO_(2)、PaCO_(2),计算氧合指数(OI)。于T_(0)、T_(3)时行电阻抗断层成像(EIT)监测,评估肺通气功能,记录中心通气区(CoV)、依赖静止区(DSS)、非依赖静止区(NSS)的面积百分比。术前1 d、术后第1、3、5天测定第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5 d内肺不张、呼吸道感染和胸腔积液等肺部并发症的发生情况。结果与H组比较,L组T_(3)时DSS面积百分比明显降低(P<0.05),PaO_(2)与OI明显升高(P<0.05),术后第1天FVC、FEV_(1)和FEV_(1)/FVC均明显升高(P<0.05),术后第3天FEV_(1)/FVC明显升高(P<0.05),术后5 d内肺不张发生率明显降低(P<0.05)。结论与FiO_(2)80%比较,术中FiO_(2)30%可以明显改善老年患者腹腔镜前列腺癌根治术后30 min肺通气、氧合功能与术后早期的肺功能,减少术后肺不张的发生。Objective To investigate the effects of intraoperative fraction of inspiration oxygen(FiO_(2))30%and 80%on pulmonary function after laparoscopic radical prostatectomy for prostate cancer in elderly patients.Methods Sixty elderly patients,aged≥65 years,BMI 18-30 kg/m^(2),ASA physical statusⅡorⅢ,underwent elective laparoscopic radical prostatectomy for prostate cancer were selected.The patients were divided into two groups:the FiO_(2)30%group(group L)and the FiO_(2)80%group(group H),30 patients in each group.After tracheal intubation,the patients were manoeuvred,and inhaled oxygen concentration was adjusted by 30%until the removal of the tracheal tube in group L.In group H,inhaled oxygen concentration was adjusted by 80%until the removal of the tracheal tube.HR and MAP were recorded 5 minutes after admission(T_(0)),1 hour after the start of surgery(T_(1)),2 hours after the start of surgery(T_(2)),and 30 minutes after extubation(T_(3)),arterial blood gas analysis was performed to record PaO_(2)and PaCO_(2),and the oxygenation index(OI)was calculated.Electrical impedance tomography(EIT)monitoring was performed at T_(0)and T_(3)to assess the pulmonary ventilation function,and the percentage of the area of the central ventilation zone(CoV),dependent static zone(DSS),and non-dependent static zone(NSS)were recorded.Exertional expiratory volume in the first second(forecd expirtory volume in the first second,FEV_(1)),exertional lung capacity(forecdvital cipitory,FVC),and 1-second rate(FEV_(1)/FVC)were measured on preoperative day 1,postoperative day 1,postoperative day 3 and postoperative day 5.The occurrence of pulmonary complications such as atelectasis,respiratory infection,and pleural effusion within 5 days postoperatively were recorded.Results Compared with group H,the percentage of DSS area at T_(3)was significantly decreased(P<0.05),PaO_(2)and OI were significantly increased(P<0.05),FVC,FEV_(1),and FEV_(1)/FVC on postoperative day 1 were significantly increased(P<0.05),FEV_(1)/FVC on postoperative day 3 was si

关 键 词：吸入氧浓度 电阻抗断层成像 老年 前列腺癌 肺功能 

分 类 号：R737.25[医药卫生—肿瘤]