熵指数联合保护性肺通气对老年腹腔镜结肠癌根治术患者肺功能、血流动力学及血气指标的影响  

Effect of entropy index combined with protective lung ventilation on perioperative lung function in elderly patients undergoing laparoscopic radical resection of colon cancer

作　　者：王蕴畅 刘永兰 方爱莉 张宁 姜先红 WANG Yun-chang;LIU Yong-lan;FANG Ai-li(Department of Anesthesiology,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Third Hospital of Shanxi Medical University,Taiyuan Shanxi 030032,China;Department of Rehabilitation Medicine,The 985th Hospital of the Joint Logistics Support Force of China People's Liberation Army,Taiyuan Shanxi 030001,China)

机构地区：[1]山西白求恩医院(山西医学科学院同济山西医院山西医科大学第三医院)麻醉科,山西太原030002 [2]中国人民解放军联勤保障部队第九八五医院康复医学科,山西太原030001

出　　处：《临床和实验医学杂志》2024年第12期1284-1288,共5页Journal of Clinical and Experimental Medicine

基　　金：山西省卫健委科研计划项目(编号:2021KF659)。

摘　　要：目的观察熵指数联合保护性肺通气对老年腹腔镜结肠癌根治术患者肺功能、血流动力学及血气指标的影响。方法以回顾性分析为法,观察对象为2020年10月至2023年2月山西白求恩医院入院的70例老年腹腔镜结肠癌根治术患者,参考治疗方式不同分为常规组(n=23)、保护组(n=23)和联合组(n=24)。常规组给予常规肺通气治疗,保护组给予保护性肺通气治疗,联合组给予熵指数联合保护性肺通气治疗。比较3组患者不同时间段[气管插管后(T_(0))、气腹后30 min(T_(1))、气腹后1.5 h(T_(2))、气腹停止后10 min(T_(3))]的肺功能指标(呼吸指数、氧合指数)、血流动力学指标[平均动脉压(MAP)、心率]、血气指标[动脉血二氧化碳分压(PCO_(2))、动脉血氧分压(PaO_(2))]、呼吸力学指标[肺顺应性(CL)、气道峰压(Ppeak)、平均气道压(Pmean)]与术中麻醉药用量(罗库溴铵、舒芬太尼)、术后苏醒时间、拔管时间、呼吸恢复时间及并发症(呼吸衰竭、肺栓塞、肺不张、低氧血症)发生率。结果3组患者T_(1)、T_(2)、T_(3)的呼吸指数、氧合指数、MAP、PaO_(2)、Ppeak、Pmean均明显高于T_(0),T_(1)、T_(2)、T_(3)的CL明显低于T_(0),差异均有统计学意义(P<0.05);保护组、联合组T_(1)、T_(2)、T_(3)的呼吸指数、氧合指数、PaO_(2)、CL均明显高于常规组,Ppeak、Pmean均明显低于常规组,差异均有统计学意义(P<0.05);且联合组T_(1)、T_(2)、T_(3)的呼吸指数、氧合指数、PaO_(2)、CL均明显高于保护组,Ppeak、Pmean均明显低于保护组,差异均有统计学意义(P<0.05)。3组患者心率、PCO_(2)组间、组内比较,差异均无统计学意义(P>0.05)。保护组、联合组患者麻醉药用量明显少于常规组,苏醒、拔管及呼吸恢复时间均明显短于常规组,差异均有统计学意义(P<0.05);且联合组患者麻醉药用量明显少于保护组,苏醒、拔管及呼吸恢复时间均明显短于保护组,差异均有统计学Objective To observe the effect of entropy index combined with protective lung ventilation on lung function,hemodynamics and blood gas indexes in elderly patients undergoing laparoscopic radical operation for colon cancer.Methods In retrospective analysis,70 elderly patients with laparoscopic radical resection of colon cancer admitted to Shanxi Bethune Hospital from March 2020 to October 2023 were observed.The patients were divided into the conventional group(n=23),the protection group(n=23)and the combination group(n=24).The conventional group received conventional lung ventilation therapy,the protection group received protective lung ventilation therapy,the combination group received entropy index combined with protective lung ventilation.The pulmonary function indexes(respiratory index,oxygenation index),hemodynamic indexes[mean arterial pressure(MAP),heart rate],blood gas indexes[partial arterial carbon dioxide pressure(PCO_(2)),partial arterial oxygen pressure(PaO_(2))],respiratory mechanics indexes[lung compliance(CL),airway peak pressure(Ppeak),average airway pressure(Pmean)]at different time periods[after tracheal intubation(T_(0)),30 minutes after pneumoperitoneum(T_(1)),1.5 hours after pneumoperitoneum(T_(2)),and 10 minutes after pneumoperitoneum cessation(T_(3))]and postoperative anesthetic dosage,recovery time,extubation time,respiratory recovery time,and incidence of complications(respiratory failure,pulmonary embolism,atelectasis,hypoxemia)were compared among the three groups.Results The respiratory index,oxygenation index,MAP,PaO_(2),Ppeak,and Pmean of T_(1),T_(2),and T_(3) patients among the three groups were significantly higher than T_(0),while the CL of T_(1),T_(2),and T_(3) was significantly lower than T_(0),the differences were statistically significant(P<0.05).The respiratory index,oxygenation index,PaO_(2),and CL of T_(1),T_(2),and T_(3) in the protection group and combination group were significantly higher than those in the conventional group,while Ppeak and Pmean were significantly lower

关 键 词：老年人 腹腔镜结肠癌根治术 熵指数 肺通气 肺功能 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]