动态二氧化碳气腹压力对腹腔镜下食管癌根治术患者术中低体温和术后恢复的影响  

Influence of dynamic carbon dioxide pneumoperitoneum pressure on intraoperative hypothermia and postoperative recovery in patients undergoing laparoscopic radical resection for esophageal cancer

作　　者：秦瑞娟 李玮浩[2] 尚震月 QIN Ruijuan;LI Weihao;SHANG Zhenyue(Operation Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,He’nan,China;Department of Thoracic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,He’nan,China)

机构地区：[1]郑州大学第一附属医院手术部,郑州4500000 [2]郑州大学第一附属医院胸外科,郑州4500000

出　　处：《癌症进展》2024年第17期1921-1925,共5页Oncology Progress

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210346)。

摘　　要：目的探讨动态二氧化碳气腹压力对腹腔镜下食管癌根治术患者术中低体温和术后恢复的影响。方法将106例腹腔镜下食管癌根治术患者根据术中二氧化碳气腹压力方式的不同分为对照组(n=58,术中不改变二氧化碳气腹压力)和观察组(n=48,术中动态二氧化碳气腹压力)。比较两组患者的血流动力学指标[收缩压(SBP)、舒张压(DBP)、心率(HR)]、体温、肺功能指标[肺活量、最大通气量(MVV)、第一秒用力呼吸容积(FEV1)]、炎症因子[白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)]和恢复质量[40项恢复质量评分(QoR-40)]。结果周围淋巴结清扫期、消化道重建期,对照组患者SBP、DBP、HR均高于肿瘤切除期,观察组患者HR均高于肿瘤切除期,差异均有统计学意义(P﹤0.05)。气腹建立后至手术结束时,观察组患者体温均高于对照组,观察组患者术中低体温发生率为52.08%,低于对照组患者的72.41%,差异均有统计学意义(P﹤0.05)。术后3天,两组患者肺活量、MVV、FEV1及IL-6、PCT、CRP水平均低于本组术前1天,观察组患者肺活量、MVV、FEV1均高于对照组,IL-6、PCT、CRP水平均低于对照组,差异均有统计学意义(P﹤0.05)。术后3天、出院时,对照组患者QoR-40各维度评分均低于本组术前1天和观察组患者,观察组患者QoR-40各维度评分先降低后升高,差异均有统计学意义(P﹤0.05)。结论腹腔镜下食管癌根治术中采用动态二氧化碳气腹压力,有利于维持患者术中血流动力学稳定,改善术中低体温情况,维持肺功能指标及炎症因子水平稳定,术后恢复质量较好。Objective To explore the influence of dynamic carbon dioxide pneumoperitoneum pressure on intraoperative hypothermia and postoperative recovery in patients undergoing laparoscopic radical resection for esophageal cancer.Method A total of 106 patients who underwent laparoscopic radical resection for esophageal cancer were divided into control group(n=58,carbon dioxide pneumoperitoneum pressure no change during surgery)and observation group(n=48,dynamic carbon dioxide pneumoperitoneum pressure during surgery)based on the different methods of carbon dioxide pneumoperitoneum pressure during surgery.The hemodynamic indicators[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)],body temperature,lung function indicators[vital capacity,maximum ventilation volume(MVV),forced expiratory volume in one second(FEV1)],inflammatory factors[interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)],and recovery quality[40-item quality of recovery score(QoR-40)]were compared between the two groups.Result During the period of peripheral lymph node dissection and gastrointestinal reconstruction,the SBP,DBP,and HR of the control group were higher than those during tumor resection,while the HR of the observation group were higher than those during tumor resection,and the differences were statistically significant(P<0.05).From the establishment of pneumoperitoneum to the end of surgery,the body temperature of the observation group were higher than those of the control group,the incidence of hypothermia during surgery in the observation group was 52.08%,which was lower than 72.41%of the control group,and the differences were statistically significant(P<0.05).Three days after surgery,the vital capacity,MVV,FEV1,IL-6,PCT,and CRP levels of both groups were lower than those at one day before surgery,the vital capacity,MVV,FEV1 of observation group were higher than those of control group,the levels of IL-6,PCT,and CRP were lower than those of control group,and the differences were statistically significant(P<0.05

关 键 词：腹腔镜下食管癌根治术 动态二氧化碳气腹压力 术中低体温 术后恢复 

分 类 号：R735.1[医药卫生—肿瘤]