麻醉后监测治疗室内呼吸训练减少妇科腹腔镜手术患者术后肺不张  

Respiratory training in the post‑anesthesia care unit reduces postoperative pulmonary atelectasis in patients undergoing gynecologic laparoscopic surgery

作　　者：徐艳慧 高航[2] 田野[1] 马帅 徐莹[1] Xu Yanhui;Gao Hang;Tian Ye;Ma Shuai;Xu Ying(Department of Anesthesiology,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Anesthesiology,Fushun City Central Hospital of China Medical University,Fushun 113006,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004 [2]中国医科大学抚顺市中心医院麻醉科,抚顺113006

出　　处：《国际麻醉学与复苏杂志》2024年第5期486-491,共6页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(82271294);辽宁省科学自然基金(2021⁃MS⁃201);辽宁省教育厅基础科学研究计划(LJK⁃MZ20221178);盛京医院345人才工程(M1427)。

摘　　要：目的探讨在麻醉后监测治疗室(PACU)内尽早进行呼吸训练对妇科腹腔镜手术患者术后肺不张发生的影响。方法以2022年11月至2023年4月共62例全麻下行妇科腹腔镜手术患者为研究对象,剔除后采用区组随机分组法将患者分为呼吸训练组(R组,30例)和对照组(C组,30例)。两组患者入PACU后均面罩吸氧,其中R组患者在意识清醒、可配合时由护士辅助将面罩贴合于面部进行呼吸训练,分别在麻醉机手动模式下限压阀设定为5、5、10 cmH_(2)O(1 cmH_(2)O=0.098 kPa)时,嘱R组患者深吸气和深呼气,每3次深呼吸为一组,每组间隔5 min,总训练共计3组;C组患者常规监测吸氧,不做干预。应用超声技术对肺部进行分区域(共12个区域)扫查并使用改良肺超声评分(LUS)在入手术室后(T_(1))、麻醉结束拔出气管导管后(T_(2))、出PACU时(T_(3))进行评分,每个区域的评分为0~3分,两侧总评分为0~36分。记录两组患者的一般资料,肺不张发生例数,T_(1)、T_(2)、T_(3)时刻的改良LUS,T_(3)时刻脉搏血氧饱和度(SpO_(2))以及术后随访48 h内有无低氧血症、呼吸困难、肺炎的发生。结果两组患者一般资料差异均无统计学意义(均P>0.05)。与T_(2)比较,T_(3)时刻两组患者改良LUS、肺不张发生例数均降低,差异有统计学意义(均P<0.05)。T_(2)时刻R组与C组肺不张发生例数与改良LUS差异无统计学意义(均P>0.05);T_(3)时刻R组肺不张发生例数与改良LUS低于C组,差异有统计学意义(均P<0.05)。R组患者在T_(3)时刻SpO_(2)较C组患者高,差异有统计学意义(P<0.05)。随访两组患者均未出现术后低氧血症、呼吸困难、肺炎。结论PACU内早期呼吸训练可明显改善全麻术后改良LUS,减少妇科腹腔镜手术患者术后肺不张的发生。Objective To investigate the effect of early respiratory training in the post‑anesthesia care unit(PACU)on postoperative pulmonary atelectasis in patients undergoing gynecologic laparoscopic surgery.Methods A total of 62 patients who underwent gynecological laparoscopic surgery under general anesthesia from November 2022 to April 2023 were included in the study.After exclusion and using the block randomization method,the patients were divided into two groups:a respiratory training group(group R,n=30)and a control group(group C,n=30).After admission to PACU,all the patients were subject to oxygen inhalation by mask.Patients in group R,when they were conscious and could cooperate,underwent breathing training with the assistance of nurses through fitting the mask to their faces.When the lower pressure limit of the anesthesia machine in the manual mode was set as 5,5,and 10 cmH_(2)O(1 cmH_(2)O=0.098 kPa),the patients were instructed to inhale and exhale deeply,and three deep breaths were set as one group,with an internal of 5 min per group for a total of three groups.Patients in group C were routinely monitored for oxygenation,without intervention.Ultrasound technology was applied to scan the lungs in subregions(12 regions in total)and scored using the modified lung ultrasound score(LUS)upon admission to the operating room(T_(1)),after removal of the tracheal tube at the end of anesthesia(T_(2)),and at the time of PACU discharge(T_(3)).The scores ranged from 0 to 3 points for each region,and the total score was 0 to 36 points on both sides.Their general information,the number of cases of pulmonary atelectasis,the modified LUS at T_(1),T_(2)and T_(3),the pulse oxygen saturation(SpO_(2))at T_(3),and the incidences of hypoxemia,dyspnea and pneumonia within the postoperative follow‑up of 48 h were recorded.Results There was no statistical difference in general information between the two groups(all P>0.05).Compared with those at T_(2),both groups showed decreases in modified LUS and the number of cases of pulmonary a

关 键 词：肺不张 呼吸训练 麻醉后监测治疗室 

分 类 号：R614[医药卫生—麻醉学]