不同吸入氧浓度对腹腔镜下腹部手术老年患者术后并发症的影响  

作　　者：虞周 王宏伟 

机构地区：[1]浙江中医药大学附属富阳第一医院(杭州市富阳区第一人民医院),311400 [2]浙江中医药大学附属省立同德医院(浙江省立同德医院),310012

出　　处：《浙江临床医学》2024年第11期1700-1701,1705,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨30%与80%吸入氧浓度(FiO2)对接受择期腹腔镜下腹部手术的老年患者术后并发症的影响。方法选择66例老年患者,年龄≥65周岁,ASA分级为Ⅰ、Ⅱ或者Ⅲ级,预期手术或麻醉时间≥2 h。患者随机分为两组:30%FiO2组(A组)和80%FiO2组(B组)。记录患者一般情况,比较两组术前(麻醉诱导前)和术后(2 h、24 h、48 h)N末端B型利钠肽前体(NT-proBNP)浓度最高值、非心脏手术后心肌损伤(MINS)发生率、7 d内术后并发症(PPCs)的发生率(根据临床症状、体格检查、胸部CT影像、血液检验、微生物学证据等综合判断)以及术前(麻醉诱导前)和术后(2 h、24 h、48 h)肌酐浓度最高值,同时,记录术后切口感染、恶心呕吐、术后30d内心力衰竭、心肌梗死、新发心律失常等。结果两组患者在术前术后NT-proBNP浓度最高值、MINS发生率、肾功能保护、术后切口感染等方面差异无统计学意义(P>0.05),但在PPCs(肺不张、肺部感染、胸腔积液、气胸、呼吸衰竭等)的发生率方面,差异有统计学意义(P<0.05)。结论术中使用30%的FiO2可能对接受择期腹腔镜下腹部手术的老年患者PPCs发生率具有潜在益处。Objective To investigate the impact of 30%and 80%inspired oxygen concentration(FiO2)on postoperative complications in elderly patients undergoing elective laparoscopic abdominal surgery.Methods A total of 66 elderly patients,aged≥65 years,with American society of anesthesiologists(ASA)classification of I,II,or III,and an expected surgical or anesthesia time of≥2 hours,were selected.Patients were randomly divided into two groups:the 30%FiO2 group(Group A)and the 80%FiO2 group(Group B).General conditions of the patients were recorded,and the highest values of N-terminal pro-B-type natriuretic peptide(NT-proBNP)concentration before and after surgery(2 hours,24 hours,and 48 hours),the incidence of myocardial injury after non-cardiac surgery(MINS),the incidence of postoperative complications within 7 days(PPCs),and the highest values of creatinine concentration before and after surgery(2 hours,24 hours,and 48 hours)were compared between the two groups.Additionally,postoperative incision infection,nausea and vomiting,heart failure,myocardial infarction,and new-onset arrhythmia within 30 days after surgery were recorded.Results There were no statistically significant differences in the highest values of NT-proBNP concentration before and after surgery,the incidence of MINS,renal function protection,and postoperative incision infection between the two groups(P>0.05).However,there was a statistically significant difference in the incidence of PPCs(atelectasis,pulmonary infection,pleural effusion,pneumothorax,respiratory failure,etc.)(P<0.05).Conclusion The use of 30%FiO2 during surgery may have potential benefits in reducing the incidence of PPCs in elderly patients undergoing elective laparoscopic abdominal surgery.

关 键 词：吸入氧浓度 非心脏手术后心肌损伤发生率 N末端B型利钠肽前体 并发症发生率 老年患者 

分 类 号：R614[医药卫生—麻醉学]