[1]谢　阳,赵李红,杨昌建,等.不同肺复张策略治疗腹腔镜下结直肠癌根治术患者围手术期肺不张疗效观察[J].新乡医学院学报,2021,38(9):857-863.[doi:10.7683/xxyxyxb.2021.09.012]
　XIE Yang,ZHAO Lihong,YANG Changjian,et al.Effect of different lung recruitment strategies in treatment of perioperative atelectasis of patients undergoing laparoscopic radical resection of colorectal cancer[J].Journal of Xinxiang Medical University,2021,38(9):857-863.[doi:10.7683/xxyxyxb.2021.09.012]
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不同肺复张策略治疗腹腔镜下结直肠癌根治术患者围手术期肺不张疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年9
页码:
857-863
栏目:
临床研究
出版日期:
2021-09-05

文章信息/Info

Title:
Effect of different lung recruitment strategies in treatment of perioperative atelectasis of patients undergoing laparoscopic radical resection of colorectal cancer
作者:
谢　阳1; 赵李红1; 杨昌建1; 钱美娟1; 谢　红2
（ 1.南京医科大学姑苏学院/南京医科大学附属苏州医院/苏州市立医院麻醉科，江苏　苏州　215002；2.苏州大学附属第二医院麻醉科，江苏　苏州　215004）
Author(s):
XIE Yang1; ZHAO Lihong1; YANG Changjian1; QIAN Meijuan1; XIE Hong2
（ 1.Department of Anesthesiology,Gusu School,Nanjing Medical University,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,Jiangsu Province,China2.Department of Anesthesiology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China）
关键词:
肺复张; 结直肠癌; 肺部超声; 肺保护
Keywords:
alveolar recruitmentradical colorectectomylung ultrasoundlung protection
分类号:
R735.3
DOI:
10.7683/xxyxyxb.2021.09.012
文献标志码:
A
摘要:
目的　探讨不同间隔时间肺复张对腹腔镜下结直肠癌根治术患者围手术期肺不胀的治疗效果。方法　选择 2019年6月至2020年5月于南京医科大学附属苏州医院麻醉科择期行腹腔镜下结直肠癌根治术的81例结直肠癌患者为研究对象，按气腹后不同间隔时间肺复张策略分为P30组（每30 min肺复张1次）、P60组（每60 min肺复张1次）和对照组（围术期不进行肺复张），每组27例。3组患者均行常规全身麻醉；P30组患者于气腹开始后采用呼气末正压（PEEP）递增法进行肺复张，每30 min 肺复张1次，共计8～10次；P60组患者于气腹开始后采用PEEP递增法进行肺复张，每60 min肺复张1次，共4～5次；对照组患者不进行肺复张。比较3组患者气腹时间、机械通气时间、补液量、出血量及住院时间等术中及术后一般资料；分别于气管插管前20 min（T1）、拔管后20 min（T2）和术后24 h（T3），对3组患者进行十二分区法肺部超声检查，采用半定量评分标准计算肺部超声评分（LUS）；分别于插管后5 min（G1）和气腹结束后5 min （G2），对3组患者进行动脉血气分析，比较3组患者的pH值、动脉血二氧化碳分压（PaCO2）和氧合指数（PaO2/FiO2）；分别于肺复张前、复张中、复张后，经桡动脉有创监测P30组和P60组患者平均动脉压（MAP）、心率（HR）变化。结果　3组患者气腹时间、机械通气时间、补液量、出血量及住院时间比较差异无统计学意义（P>0.05）。3组患者T2、T3时LUS总分显著高于T1时（P<0.01）；对照组患者T3时LUS总分显著低于T2 时（P<0.01）；P30组患者T3时LUS总分显著高于T2 时（P<0.01）；P60组患者T2与T3时LUS总分比较差异无统计学意义（P>0.05）。T1、T3时，3组患者间LUS总分比较差异无统计学意义（P>0.05）；T2 时，P30组和P60组患者LUS总分显著低于对照组， P30组患者LUS总分显著低于P60组（P<0.01）。3组患者T1、T2、T3时的总前LUS评分比较差异无统计学意义（P>0.05）；3组患者T2、T3时的总侧和总背LUS评分显著大于T1时（P<0.01）；3组患者T2与T3时的总侧LUS评分比较差异无统计学意义（P>0.05）；对照组患者T3时的总背LUS评分显著小于T2时，P30组患者T3时的总背LUS评分显著大于T2时（P<0.01）；P60组患者T2与T3时的总背LUS评分比较差异无统计学意义（P>0.05）。T1、T2、T3时，3组患者的总前、总侧LUS评分比较差异无统计学意义（P>0.05）；T1、T3时，3组患者的总背LUS评分比较差异无统计学意义（P>0.05）；T2时，P30组和P60组患者的总背LUS评分显著小于对照组，P60组患者的总背LUS评分显著大于P30组（P<0.01）。3组患者组间及组内G1、G2 时的 pH、PaCO2比较差异无统计学意义（P>0.05）；P30和P60组患者G2时的PaO2/FiO2显著高于G1（P<0.05）；对照组患者G1时与 G2 时的PaO2/FiO2比较差异无统计学意义（P>0.05）。G1时，3组患者间的 PaO2/FiO2比较差异无统计学意义（P>0.05）；G2时，P30组和P60组患者的PaO2/FiO2显著高于对照组（P<0.05），P30组与P60组患者的PaO2/FiO2比较差异无统计学意义（P>0.05）。P30组和P60组复张中的MAP显著低于复张前和复张后（P<0.05）；2组患者复张前与复张后的MAP比较差异无统计学意义（P>0.05）；2组患者复张前、复张中、复张后的HR比较差异无统计学意义（P>0.05）。结论　肺复张可增加腹腔镜下结直肠癌根治术患者围手术期肺部含气量，改善术中氧合，间隔30 min复张1次比间隔60 min复张1次对拔管后20 min肺不张的改善效果更显著；肺复张过程中可对患者血流动力学产生短暂影响。
Abstract:
Objective　To investigate the therapeutic effect of different intervals of lung recruitment on perioperative atelectasis in patients who underwent laparoscopic radical resection of colorectal cancer.Methods　A total of 81 patients underwent elective laparoscopic radical resection of colorectal cancer in the Department of Anesthesiology,Suzhou Municipal Hospital Affiliated to Nanjing Medical University from June 2019 to May 2020 were selected as study subjects,and they were divided into P30 group (once every 30 minutes for lung recruitment),P60 group (once every 60 minutes for lung recruitment) and control group (without lung recruitment during perioperative period) according to the strategy of lung recruitment at different intervals after pneumoperitoneum,with 27 cases in each group.All patients received routine general anesthesiaafter pneumoperitoneum,patients in the P30 group underwent lung recruitment by increasing end expiratory positive pressure (PEEP),once every 30 minutes,a total of 8-10 timespatients in the P60 group underwent lung recruitment by increasing PEEP after pneumoperitoneum,once every 60 minutes,a total of 4-5 timespatients in the control group did not undergo lung recruitment.The intraoperative and postoperative general data including the pneumoperitoneum time,mechanical ventilation time,rehydration volume,bleeding volume and hospitalization time were compared among the three groupslung ultrasound was performed on the patients with twelve zone method in the three groups at 20 minutes before endotracheal intubation (T1),20 minutes after extubation (T2)and 24 hours after operation (T3),and the lung ultrasound score (LUS) was calculated by semi quantitative scoring standardarterial blood gas analysis of patients in the three groups was performed at 5 minutes after intubation(G1) and 5 minutes after pneumoperitoneum(G2),and the pH value,arterial carbon dioxide partial pressure (PaCO2) and oxygenation index (PaO2/FiO2) of patients were compared among the three groupsthe changes of mean arterial pressure (MAP) and heart rate (HR) of patients in the P30 group and P60 group were monitored by radial artery before,during and after pulmonary recruitment.Results　There was no significant difference in pneumoperitoneum time,mechanical ventilation time,rehydration volume,bleeding volume and hospitalization time of patients among the three groups (P>0.05).The total score of LUS at T2 and T3 was significantly higher than that at T1 in the three groups (P<0.01),the total score of LUS at T3 was significantly lower than that at T2 in the control group (P<0.01),the total score of LUS at T3 was significantly higher than that at T2 in the P30 group (P<0.01),there was no significant difference in the total score of LUS between T2 and T3 in the P60 group (P>0.05)at T1 and T3,there was no significant difference in the total score of LUS among the three groups (P> 0.05)at T2,the total score of LUS in the P30 group and P60 group was significantly lower than that in the control group,and the total score of LUS in the P30 group was significantly lower than that in the P60 group (P<0.01).There was no significant difference in the LUS scores of total front side at T1,T2 and T3 among the three groups (P>0.05)the LUS scores of total lateral side and total dorsal side at T2 and T3 were significantly higher than those at T1 in the three groups (P<0.01),there was no significant difference in the LUS score of total lateral side between T2 and T3 in the three groups (P>0.05)the LUS score of total dorsal side at T3 was significantly lower than that at T2 in the control group,and the LUS score of total dorsal side at T3 was significantly higher than that at T2 in the P30 group (P< 0.01),there was no significant difference in the LUS score of total dorsal side between T2 and T3 in the P60 group (P>0.05).At T1,T2 and T3,there was no significant difference in the LUS scores of total front side and total lateral side among the three groups (P>0.05)at T1 and T3,there was no significant diffe-rence in the LUS score of total dorsal side among the three groups (P>0.05)at T2,the LUS score of total dorsal side of patients in the P30 group and P60 group was significantly lower than that in the control group,and the LUS score of total dorsal side of patients in the P60 group was significantly higher than that in the P30 group (P<0.01).There was no significant difference in pH and PaCO2 between G1 and G2 in the three groups and among the three groups at G1 and G2 (P>0.05),PaO2/FiO2 at G2 was significantly higher than that in G1 in the P30 group and P60 group (P<0.05),there was no significant difference in PaO2/FiO2 between G1 and G2 in the control group (P>0.05).At G1,there was no significant difference in PaO2/FiO2 among the three groups (P>0.05)at G2,PaO2/FiO2 of patients in the P30 group and P60 group was significantly higher than that in the control group (P<0.05),there was no significant difference in PaO2/FiO2 between the P30 group and P60 group (P>0.05).MAP of patients during recruitment was significantly lower than that before and after recruitment in the P30 group and P60 group (P<0.05),there was no significant difference in MAP before and after recruitment in the two groups (P>0.05),there was no significant difference in HR before,during and after recruitment in the two groups (P>0.05).Conclusion　Lung recruitment can increase postoperative pulmonary air content and improve intraoperative oxygenation.The effect of lung recruitment at an interval of 30 minutes on atelectasis at 20 minutes after extubation is better than that of lung recruitment at an interval of 60 minutesduring the process of lung recruitment,lung recruitment will have a temporary impact on the hemodynamics of patients.

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更新日期/Last Update: 2021-09-05