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| 肺保护性通气策略对中老年患者结直肠癌根治术后肺部并发症和血清JAK1/STAT3的影响 |
| Effect of lung-protective ventilation strategy on postoperative pulmonary complications and expression of serum JAK1/STAT3 in middle-aged and elderly patients undergoing laparoscopic radical resection of colorectal cancer |
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| DOI：10.12089/jca.2026.08.005 |
| 中文关键词: 正压通气 Janus激酶1 信号转导和转录激活子3 术后肺部并发症 |
| 英文关键词: Positive-pressure respiration Janus kinase 1 Signal transducer and activator of transcription 3 Postoperative pulmonary complications |
| 基金项目:南通市卫健委资助项目（MS2023025） |
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| 中文摘要: |
目的： 观察肺保护性通气策略对腹腔镜结直肠癌根治术中老年患者术后肺部并发症（PPCs）及血清Janus激酶（JAK1）/信号转导与转录激活因子3（STAT3）表达的影响，评估血清JAK1/STAT3表达在肺保护性通气策略改善中老年患者结直肠癌手术后肺部并发症中的作用。
方法： 选择2024年1—6月择期结直肠癌根治术、术前预测发生PPCs中危风险的患者，年龄50～74岁，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：肺保护性通气组（GP组）和传统通气组（GC组）。GP组采用肺保护性通气策略，机械通气后每隔30 min进行一次手法肺复张；GC组采用传统通气策略。主要指标为术后7 d内PPCs发生率。次要指标包括插管后5 min、气腹后1、2 h、术毕时气道峰压（Ppeak）、气道平台压（Pplat）、动态肺顺应性（Cdyn），麻醉诱导前10 min、术后1、24 h血清JAK1、STAT3浓度。不良反应包括支气管痉挛、呼吸衰竭、气胸、肺部感染、肺不张、吸入性肺炎和胸腔积液。
结果： 共纳入患者58例，每组29例。与GC组，比较，GP组术后7 d内PPCs发生率明显降低（P<0.05），术毕时Pplat明显降低（P<0.05），气腹后2 h和术毕时Ppeak明显降低、Cdyn明显升高（P<0.05），手术结束后1 h血清JAK1、STAT3的浓度明显降低（P<0.05）。
结论： 肺保护性通气策略可以抑制中老年结直肠癌根治手术患者血清JAK1、STAT3的过度表达，降低PPCs发生率。 |
| 英文摘要: |
Objective: To observe the effects of lung-protective ventilation strategy on postoperative pulmonary complications (PPCs) and the expression of serum Janus kinase 1 (JAK1)/signal transducer and activator of transcription 3 (STAT3) in middle-aged and elderly patients undergoing laparoscopic radical resection of colorectal cancer, and to evaluate the role of serum JAK1/STAT3 expression in the improvement of postoperative pulmonary complications by lung-protective ventilation in middle-aged and elderly patients with colorectal cancer.
Methods: Patients scheduled for elective radical colorectal cancer surgery with a moderate risk of postoperative pulmonary complications (PPCs) from January 2024 to June 2024 were enrolled, aged 50-74 years, ASA physical status Ⅱ or Ⅲ. Patients were randomized into two groups using a random number table method: the lung-protective ventilation group (group GP) and the conventional ventilation group (group GC). Eligible participants were randomized using a random number method to receive either lung-protective ventilation or conventional ventilation. Group GP received lung-protective ventilation strategy, and manual lung recruitment maneuvers were performed every 30 minutes after mechanical ventilation was initiated. Group GC was managed with conventional ventilation strategy. The primary outcome was the incidence of PPCs within 7 days postoperatively. Secondary outcomes included peak airway pressure (Ppeak), plateau airway pressure (Pplat), and dynamic lung compliance (Cdyn) at 5 minutes after tracheal intubation, 1 hour and 2 hours after pneumoperitoneum establishment, and at the end of surgery, serum levels of JAK1 and STAT3 were detected at 10 minutes before anesthesia induction, 1 hour and 24 hours after operation. Adverse reactions included bronchospasm, respiratory failure, pneumothorax, pulmonary infection, atelectasis, aspiration pneumonia and pleural effusion.
Results: Fifty-eight patients were included in this study, 29 patients in each group. Compared with group GC, the incidence of PPCs within 7 days postoperatively were significantly decreased, Pplat at the end of surgery was significantly decreased, Ppeak at 2 hours after pneumoperitoneum and at the end of surgery were significantly decreased while Cdyn at 2 hours after pneumoperitoneum and at the end of surgery were significantly increased, serum levels of JAK1 and STAT3 at 1 hour after surgery were significantly decreased in group GP (P < 0.05).
Conclusion: Lung-protective ventilation can inhibit the overexpression of serum JAK1 and STAT3 in middle-aged and elderly patients undergoing radical colorectal cancer surgery, thereby reducing the incidence of postoperative pulmonary complications. |
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