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| 肺保护性通气策略对腹腔镜胃癌根治手术老年患者肺氧合功能及术后肺部并发症的影响 |
| Effect of intraoperative lung protective mechanical ventilation on pulmonary oxygenation function and postoperative pulmonary complications after laparoscopic radical gastrectomy fo |
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| DOI：10.12089/jca.2019.04.008 |
| 中文关键词: 保护性通气策略；腹腔镜 胃癌根治；肺氧合功能；术后肺部并发症；老年 |
| 英文关键词: Lung protective ventilation strategy Laparoscopic Radical gastrectomy Pulmonary oxygenation function Postoperative pulmonary complications Elderly |
| 基金项目:湖州市科技计划项目（2015GY23） |
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| 中文摘要: |
目的 探讨肺保护性通气策略(lung protective ventilation strategy,LPVS)对腹腔镜胃癌根治手术老年患者肺氧合功能及术后肺部并发症(postoperative pulmonary complications，PPCs）的影响。
方法 选择接受腹腔镜胃癌根治手术的老年患者115例，男69例，女46例，年龄≥65岁，ASA Ⅰ—Ⅲ级，随机分为两组：常规容量控制通气组（CV组，n=57）和肺保护性通气组（PV组，n=58）。记录插管后10 min(T1)、气腹后10 min(T2)、气腹后60 min(T3)、气腹结束10 min(T4)时的气道峰压(Ppeak)，计算肺顺应性(Cdyn)，并在T1—T4时抽取动脉血进行血气分析，计算氧合指数(OI)、肺泡动脉血氧分压差（A-aDO2）；记录术后第2天改良肺部感染评分（mCPIS）；记录术后7 d内PPCs发生情况。
结果 与T1时比较，T2时两组Cdyn均明显降低(P<0.05)；T3—T4时PV组Cdyn明显高于CV组(P<0.05)；T3—T4时PV组OI明显高于CV组、A-aDO2明显低于CV组(P<0.05)。术后第2天PV组mCPIS明显低于CV组(P<0.05)。术后7 d内PV组PPCs发生率明显低于CV组(P<0.05)。
结论 肺保护性通气策略能明显改善老年腹腔镜胃癌根治手术老年患者的肺氧合功能，降低术后肺部并发症，具有一定的肺保护作用。 |
| 英文摘要: |
Objective To evaluate the effects of lung protective ventilation strategy on pulmonary oxygenation function and postoperative pulmonary complications (PPCs) in elderly patients undergoing laparoscopic radical gastrectomy.
Methods A total of 115 elderly patients, 69 males and 46 females, aged over 65 years, ASA physical status Ⅰ-Ⅲ, scheduled to undergo laparoscopic radical gastrectomy were randomly divided into two groups: Volume controlled ventilation group (group CV, n=57) and lung protective ventilation strategy (group PV, n=58). We recorded Ppeak and Cdyn at 10 min after intubation (T1), 10 min after pneumoperitoneum (T2), 60 min after pneumoperitoneum (T3) and 10 min at the end of pneumoperitoneum (T4). Blood gas analysis was performed at T1-T4, and OI and A-aDO2 were calculated at the same time. The mCPIS was recorded the day after surgery. And the incidence of PPCs within 7 days after surgery was recorded.
Results Compared with T1, Cdyn was significantly reduced in both groups at T2 (P<0.05). At T3-T4, Cdyn and OI in group PV was significantly higher than those of group CV (P<0.05), while A-aDO2 was significantly lower than that in group CV (P<0.05). The mCPIS score was significantly lower in group PV than in group CV on the second day after surgery (P<0.05). The incidence of PPCs was lower in group PV than that in group CV within 7 days after surgery (P<0.05).
Conclusion The lung protective ventilation strategy can significantly improve the pulmonary oxygenation function and reduces postoperative pulmonary complications inelderly patients undergoing laparoscopic radical gastrectomy. |
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