肺保护性通气联合围手术期呼吸功能锻炼对老年衰弱结直肠癌手术患者预后的影响  

The effect of lung protective ventilation combined with perioperative breathing exercises on postoperative prognosis of frail elderly patients with colorectal cancer

作　　者：颜梅 申笑笑 刘迪[1] 杨勇[1] Yan Mei;Shen Xiao-xiao;Liu Di;YangYong(Department of Anesthesiology,The First People's Hospital of Neijiang,Neijiang,Sichuan 641099,China;Department of Anesthesiology,Tongchuan People's Hospital,Tongchuan,Shaanxi 727100,China)

机构地区：[1]内江市第一人民医院麻醉科,四川内江641099 [2]铜川市人民医院麻醉科,陕西铜川727100

出　　处：《中国现代医学杂志》2025年第4期91-96,共6页China Journal of Modern Medicine

基　　金：四川省医学会青年创新科研项目(No:Q22022);内江市科技计划项目(No:Z202205)。

摘　　要：目的探讨肺保护性通气联合围手术期呼吸功能锻炼对老年衰弱结直肠癌手术患者预后的影响。方法选取2021年1月—2023年6月在内江市第一人民医院就诊的92例老年衰弱结直肠癌手术患者,按摸球法分为对照组和实验组,每组46例。对照组接受常规通气模式,实验组接受肺保护性通气联合围手术期呼吸功能锻炼。比较两组患者在气腹前(T_(1))、气腹1 h(T_(2))、拔管前(T_(3))的呼吸力学指标[气道峰压(Ppeak)、平均气道压(Pmean)、肺顺应性(CL)],在麻醉诱导前(T_(0))、T_(2)、气管导管拔除后10 min(T_(4))的氧合指标[脉搏血氧饱和度(SpO_(2))、动脉氧分压(PaO_(2))、肺泡动脉血氧分压差[P(A-a)DO_(2)]]的变化,比较两组患者血清肺表面活性蛋白质A(SP-A)水平、St George's呼吸疾病问卷评估量表(SGRQ)评分、术后肺部并发症(肺炎、低氧血症、呼吸衰竭、肺不张、肺栓塞)的状况。结果两组患者T_(1)、T_(2)、T_(3)的Ppeak、Pmean和CL水平比较,结果:(1)不同时间点Ppeak、Pmean和CL水平比较,差异均有统计学意义(P<0.05);(2)两组患者Ppeak、Pmean和CL水平比较,差异均有统计学意义(P<0.05),实验组在T_(2)、T_(3)时刻Ppeak和Pmean水平低于对照组,实验组的CL水平在T_(2)、T_(3)时高于对照组;(3)两组患者Ppeak、Pmean水平变化趋势比较,差异均无统计学意义(P>0.05),两组患者CL水平变化趋势比较,差异有统计学意义(P<0.05)。两组患者T_(0)、T_(2)、T_(4)的SpO_(2)、PaO_(2)和P(A-a)DO_(2)比较,结果:(1)不同时间点SpO_(2)、PaO_(2)和P(A-a)DO_(2)比较,差异均有统计学意义(P<0.05);(2)两组患者SpO_(2)、PaO_(2)和P(A-a)DO_(2)比较,差异均有统计学意义(P<0.05),实验组SpO_(2)和PaO_(2)在T_(2)、T_(4)时高于对照组,实验组P(A-a)DO_(2)在T_(2)、T_(4)时低于对照组;(3)两组患者SpO_(2)、PaO_(2)变化趋势比较,差异均无统计学意义(P>0.05),两组患者P(A-a)DO_(2)变化趋势比较,差异有统计学意义(P<0.Objective To investigate the effect of lung protective ventilation combined with perioperative breathing exercises on postoperative prognosis of frail elderly patients with colorectal cancer.Methods From January 2021 to June 2023,a total of 92 frail elderly patients undergoing surgery for colorectal cancer were enrolled at the First People's Hospital of Neijiang.Patients were assigned to control and experimental groups by drawing lots,with 46 cases in each group.The control group received conventional ventilation modes,while the experimental group received lung protective ventilation combined with perioperative breathing exercises.Comparisons were made between the two groups on respiratory mechanics indicators[peak airway pressure(Ppeak),mean airway pressure(Pmean),and compliance of lung(CL)]before pneumoperitoneum(T_(1)),1 hour after pneumoperitoneum(T_(2)),and before extubation(T_(3)),and on oxygenation indicators[pulse oximetry saturation(SpO_(2)),partial pressure of oxygen in arterial blood(PaO_(2)),and alveolar-arterial oxygen gradient(P(A-a)DO_(2))]before anesthesia induction(T_(0)),at T_(2),and 10 minutes after tracheal tube removal(T_(4)).Serum levels of surfactant protein A(SP-A),St.George's Respiratory Questionnaire(SGRQ)scores,and postoperative pulmonary complications(pneumonia,hypoxemia,respiratory failure,atelectasis,pulmonary embolism)were also compared between the two groups.Results The Ppeak,Pmean,and CL at T_(1),T_(2) and T_(3) in the two groups were compared,which exhibited that they were different among the time points(P<0.05)and between the two groups.The experimental group had lower Ppeak and Pmean and higher CL at T_(2) and T_(3) compared with the control group.There were no significant differences in the change trends of Ppeak and Pmean between the groups(P>0.05),but significant differences in the change trends of CL were found between the groups(P<0.05).Comparison of SpO_(2),PaO_(2) and P(A-a)DO_(2) at T_(0),T_(2) and T_(4) in the two groups revealed that they were different among the time

关 键 词：结直肠癌 肺保护性通气 围手术期 呼吸功能锻炼 老年衰弱 并发症 

分 类 号：R735.3[医药卫生—肿瘤]