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| 术前肺功能锻炼联合压力控制容量保证通气模式对老年患者腹腔镜下胃癌根治术肺功能的影响 |
| Effects of preoperative pulmonary function exercise combined with pressure-controlled ventilation-volume guaranteed mode on pulmonary function in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer |
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| DOI：10.12089/jca.2023.08.007 |
| 中文关键词: 肺功能锻炼 机械通气 压力控制容量保证通气 肺功能 肺不张 |
| 英文关键词: Pulmonary function exercise Mechanical ventilation Pressure-controlled ventilation-volume guaranteed mode Pulmonary function Atelectasis |
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| 中文摘要: |
目的 探究术前肺功能锻炼联合压力控制容量保证通气（PCV-VG）模式对老年患者腹腔镜下胃癌根治术肺功能的影响。
方法 选择2021年9月至2022年3月择期行腹腔镜下胃癌根治术老年患者60例，男29例，女31例，年龄65～80岁，BMI 18～28 kg/m2，ASA Ⅱ或Ⅲ级，加泰罗尼亚外科患者呼吸风险评估表（ARISCAT）评分≥26分。采用随机数字表法将患者分为两组：术前肺功能锻炼+术中PCV-VG组（P组）和术前肺功能锻炼+术中容量控制通气模式（VCV）组（V组），每组30例。患者术前吹气球锻炼肺功能5 d。麻醉诱导后气管插管机械通气，P组行PCV-VG模式，V组行VCV模式。记录麻醉诱导后10 min（T2）、改变体位前（T3）、气腹开始后10 min（T4）、40 min（T5）、70 min（T6）、100 min（T7）、结束气腹转水平位后10 min（T8）、手术结束前30 min（T9）的气道峰压（Ppeak）、气道平台压（Pplat）、肺动态顺应性（Cdyn）及驱动压（DP）。于入院时（T0）、T5、T8、PACU拔管后1 h（T11）、术后第1天（T12）采集桡动脉血行血气分析，记录pH、PaO2、PaCO2、肺泡-动脉氧分压差（A-aDO2）。于T0、手术结束（T10）时抽取静脉血测定克拉拉细胞分泌蛋白-16（CC-16）、白细胞介素-6（IL-6）和白细胞介素-1β（IL-1β）浓度。记录T0、入手术室（T1）、T11时肺部超声（LUS）评分。记录T1、T11时肺不张发生情况及术后7 d内PPCs发生情况。
结果 与V组比较，P组T3—T8时Ppeak、Pplat、DP明显降低、Cdyn明显升高（P＜0.05），T5、T8、T11时A-aDO2明显降低（P＜0.05），T11时PaO2明显升高（P＜0.05），T10时CC-16、IL-6和IL-1β浓度明显降低（P＜0.05），T11时LUS评分及肺不张发生率均明显降低（P＜0.05）。术后7 d内两组PPCs发生率差异无统计学意义。
结论 与术前肺功能锻炼联合术中VCV模式比较，术前肺功能锻炼联合术中PCV-VG模式可以改善腹腔镜下胃癌根治术老年患者术中及术后肺功能，降低术后肺不张发生率。 |
| 英文摘要: |
Objective To investigate the effects of preoperative pulmonary function exercise combined with pressure-controlled ventilation-volume guaranteed (PCV-VG) mode in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer.
Methods Sixty patients scheduled for elective laparoscopic radical gastrectomy for gastric cancerfrom September 2021 to March 2022, 29 males and 31 females, aged 65-80 years, BMI 18-28 kg/m2, ASA physical status Ⅱ or Ⅲ, ARISCAT score ≥ 26, were randomly divided into two groups: preoperative pulmonary function exercise plus intraoperative PCV-VG group (group P) and preoperative pulmonary function exercise plus intraoperative volume-controlled ventilation (VCV) group (group V), 30 patients in each group. Patients in both groups blew up balloons to exercise their pulmonary function for 5 days before surgery. After induction of anesthesia, the patients in group P were ventilated with PCV-VG mode, and those in group V were ventilated with VCV mode, the airway peak pressure (Ppeak), airway plateau pressure (Pplat), dynamic pulmonary compliance (Cdyn), and drive pressure (DP) were recorded 10 minutes after induction of anesthesia (T2), before body position change (T3), 10 minutes (T4), 40 minutes (T5), 70 minutes (T6), 100 minutes (T7) after pneumoperitoneum, 10 minutes after the end of the pneumoperitoneum to horizontal position (T8), 30 minutes before the end of operation (T9). Arterial blood gas analysis was performed at the time of admission (T0), T5, T8, 1 hour after extubation (T11), and 1 day after surgery (T12), and values of pH, PaO2, PaCO2, and alveolar-arterial oxygen difference (A-aDO2) were recorded. The concentrations of Clara cells secrete proteins-16 (CC-16), interleukin-6 (IL-6), and interleukin-1β (IL-1β) were measured at T0 and the end of the operation (T10). The lung ultrasound score (LUS) at T0, admission to the operating room (T1), and T11 were recorded. The occurrence of pulmonary atelectasis at T1 and T11, and postoperative pulmonary complications (PPCs) within 7 days after surgery were recorded.
Results Compared with group V, Ppeak, Pplat, and DP were significantly decreased and Cdyn was significantly increased at T3-T8 (P < 0.05), A-aDO2 was significantly decreased at T5, T8, and T11 (P<0.05), PaO2 was significantly increased at T11 (P < 0.05), the concentrations of CC-16, IL-6, and IL-1β were significantly decreased at T10 (P < 0.05), the LUS scores and the incidence of atelectasis were significantly decreased at T11 in group P (P < 0.05). There was no significant difference in the incidence of PPCs within 7 days after surgery between the two groups.
Conclusion Compared with preoperative pulmonary function exercise combined with intraoperative VCV mode, preoperative pulmonary function exercise combined with intraoperative PCV-VG mode can improve intraoperative and postoperative pulmonary function and reduce the incidence of postoperative atelectasis in elderly patients undergoing laparoscopic radical gastric cancer resection. |
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