亚高原地区腹腔镜疝修补术和子宫切除术患者全身麻醉期间不同吸入氧浓度对术后恢复的影响  

Effects of different fractions of inspired oxygen during general anesthesia on postoperative recovery in patients undergoing laparoscopic hernia repair and hysterectomy in a sub-plateau region

作　　者：韩继元 怀立春 汪明辉 李玉珍 方波 HAN Jiyuan;HUAI Lichun;WANG Minghui;LI Yuzhen;FANG Bo(Department of Anesthesiology,People’s Hospital of Datong Hui and Tu Autonomous County,Xining 810100,China;Department of Second Orthopedics,People’s Hospital of Datong Hui and Tu Autonomous County,Xining 810100,China;Department of Anesthesiology,The First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]西宁市大通回族土族自治县人民医院麻醉科,西宁810100 [2]西宁市大通回族土族自治县人民医院骨二科,西宁810100 [3]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医科大学学报》2024年第8期719-724,共6页Journal of China Medical University

基　　金：西宁市科技项目(2022-M-18);辽宁省应用基础研究计划(2023JH2/101300028)。

摘　　要：目的探讨亚高原地区腹腔镜疝修补术和子宫切除术患者全身麻醉期间不同吸入氧浓度对术后恢复的影响。方法收集2022年4月至2023年11月西宁市大通回族土族自治县人民医院就诊的111例择期全身麻醉下行腹腔镜疝修补术和子宫切除术患者的临床资料。根据患者全身麻醉过程中吸入氧浓度随机分为100%氧组(n=36)、80%氧组(n=38)和60%氧组(n=37)。比较3组患者麻醉诱导前、气腹30 min及术后第1天的动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和氧合指数(OI)等呼吸相关指标。比较3组患者首次排气时间,住院时间,术后肺部并发症、切口感染、谵妄及认知功能情况。结果气腹30 min时,3组PaO_(2)均在正常范围内;60%氧组PaO_(2)低于100%氧组和80%氧组(均P<0.001)。气腹30 min时,60%氧组OI高于100%氧组(P=0.009),而80%氧组与100%氧组OI比较无统计学差异(P>0.05)。与麻醉诱导前比较,3组术后第1天PaO_(2)和OI均降低(均P<0.05),PaCO_(2)均增高(均P<0.05)。术后第1天,60%氧组PaO_(2)和OI高于100%氧组和80%氧组(均P<0.05),60%氧组PaCO_(2)低于100%氧组(P<0.001);80%氧组PaO_(2)和OI均高于100%氧组(P<0.05)。与100%氧组比较,60%氧组首次排气时间显著缩短(P=0.019)。3组患者均未发生术后切口感染。3组住院时间,术后肺部并发症、谵妄和认知功能障碍发生率比较无统计学差异(均P>0.05)。结论亚高原地区腹腔镜疝修补术和子宫切除术患者全身麻醉期间,适当降低吸入氧浓度(60%)对患者术后呼吸和胃肠道功能恢复有积极作用,且不会增加患者切口感染、术后谵妄和认知功能障碍发生率。Objective To investigate the effects of different fractions of inspired oxygen administered during general anesthesia on postoperative recovery in patients undergoing laparoscopic hernia repair and hysterectomy in a sub-plateau region.Methods Clinical data of 111 patients undergoing laparoscopic hernia repair and hysterectomy under general anesthesia were collected from the People’s Hospital of Datong Hui and Tu Autonomous County between April 2022 and November 2023.Based on the concentration of inhaled oxygen during general anesthesia,patients were randomly divided into three groups:100%oxygen(n=36),80%oxygen(n=38),and 60%oxygen(n=37).Respiratory-related parameters,including arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),and oxygenation index(OI),were compared among the three groups before anesthesia induction,30 min after pneumoperitoneum,and 1 d after surgery.Postoperative pulmonary complications,incision infections,first gastrointestinal exhaust time,and length of hospitalization were recorded.Postoperative delirium and cognitive function were also assessed.Results At 30 min after pneumoperitoneum induction,the OI in the 60%oxygen group was higher than that in the 100%oxygen group(P=0.009),whereas there was no statistical difference in OI between the 80%oxygen and 100%oxygen groups(P>0.05).PaO_(2) and OI were lower(P<0.05)and PaCO_(2) was higher(P<0.05)in all groups on the 1st day after surgery than before the induction of anesthesia.PaO_(2) and OI were higher in the 80%oxygen group than in the 100%oxygen group(all P<0.05).PaO_(2) and OI were higher in the 60%oxygen group than in the 100%oxygen and 80%oxygen groups(all P<0.05).PaCO_(2) was lower in the 60%oxygen group than in the 100%oxygen group(P<0.001).The first gastrointestinal exhaust time was shorter in the 60%oxygen group than in the 100%oxygen group(P=0.019).No postoperative incision infections were observed in any of the three groups,and there were no statistically significant differences in the i

关 键 词：亚高原地区 腹腔镜疝修补术 腹腔镜子宫切除术 全身麻醉 吸入氧浓度 术后恢复 

分 类 号：R657.4[医药卫生—外科学]