摘要
目的:评价肺开放策略(OLS)对腹腔镜手术老年衰弱患者心肺功能的影响。方法:择期全麻下拟行腹腔镜直肠肿瘤根治术或前列腺癌根治术患者84例,年龄65~80岁,BMI 18.5~30.0 kg/m 2,ASA分级Ⅱ或Ⅲ级,术前Fried衰弱量表评分≥3分,采用随机数字表法分为2组(n=42):OLS组和非OLS组(NOLS)组。OLS组患者术中给予进阶式肺复张和个体化呼气末正压(PEEP)。NOLS组患者给予5 cmH_(2)O的固定PEEP。于气管插管后10 min(T_(0))、肺复张达到峰值后即刻(T_(1))、个体化PEEP设定后30 min(T_(2))、1 h(T_(3))和手术结束前10 min(T_(4)),采用经食管超声心动图测量心功能指标,测量视神经鞘直径(ONSD),并记录动脉血气分析指标和肺功能指标。于术前、术后1和2 d采用化学发光法测定血清肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、N末端B型利钠肽原(NT-proBNP)浓度。记录术后7 d内术后肺部并发症的发生情况和术后预后指标。结果:最终纳入81例患者:NOLS组41例,OLS组40例。与NOLS组比较,OLS组T_(1),2时左心室舒张末期面积、左心室射血分数、每搏量、二尖瓣口血流舒张早期峰值速度/二尖瓣环舒张早期峰值速度比值、二尖瓣环收缩期位移、左心室整体纵向应变值、右心室舒张末期面积、右心室面积改变分数、三尖瓣环收缩期位移、右心室整体纵向应变值降低(P<0.05),其余时点上述指标差异无统计学意义(P>0.05),T_(1-4)时PaO_(2)、氧合指数、肺顺应性升高,PaCO_(2)、肺泡-动脉血氧分压差降低,术后7 d内肺部并发症总发生率降低,PACU滞留时间、首次下床活动时间和术后住院时间缩短(P<0.05),各时点ONSD、血清cTnT、CK-MB、NT-proBNP浓度差异无统计学意义(P>0.05)。结论:OLS可改善老年衰弱患者肺功能,有利于患者预后,又不会对心脏产生明显的负面影响,可安全用于无明显心功能障碍的老年衰弱患者术中气道管理。
Objective To evaluate the effect of open-lung strategy(OLS)on cardiopulmonary function in frail elderly patients undergoing laparoscopic surgery.Methods Eighty-four frail elderly patients aged 65-80 yr,with body mass index of 18.5-30.0 kg/m^(2),of American Society of Anesthesiologists physical statusⅡorⅢ,with preoperative Fried frailty phenotype scale score≥3,undergoing elective laparoscopic radical rectal cancer or radical prostate cancer surgery under general anesthesia,were divided into 2 groups(n=42 each)by the random number table method:OLS group and non-OLS group(NOLS group).The patients underwent recruitment maneuvers and individualized positive end-expiratory pressure(PEEP)in OLS group,while patients received fixed PEEP(5 cmH_(2)O)in NOLS group.At 10 min after endotracheal intubation(T_(0),baseline value),immediately after the peak of recruitment maneuvers(T_(1)),30 min(T_(2))and 1 h(T_(3))after individualized PEEP setting and 10 min before the end of surgery(T_(4)),cardiac function indexes were measured by transoesophageal echocardiography,optic nerve sheath diameter was measured,and the arterial blood gas analysis indexes and pulmonary function indexes were recorded.The levels of serum cardiac troponin T,creatine kinase-MB and precursor of type B natriuretic peptide were determined by chemiluminescence before surgery and at 1 and 2 days after surgery.The postoperative pulmonary complications within 7 days after surgery and postoperative outcomes were also recorded.Results Eighty-one patients were finally enrolled,with 41 in NOLS group and 40 in OLS group.Compared with NOLS group,the left ventricular end diastolic area,left ventricular ejection fraction,stroke volume,ratio of early mitral flow velocity to early mitral annulus velocity,mitral annular plane systolic excursion,left ventricular global longitudinal strain,right ventricular end diastolic area,right ventricular fractional area change,tricuspid annular plane systolic excusion and right ventricular global longitudinal strain were significan
作者
朱祥鹏
肖迎港
罗超
葛亚丽
张扬
高巨
Zhu Xiangpeng;Xiao Yinggang;Luo Chao;Ge Yali;Zhang Yang;Gao Ju(Department of Anesthesiology,Northern Jiangsu People′s Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2022年第12期1426-1431,共6页
Chinese Journal of Anesthesiology
基金
国家自然科学基金(82172190)
江苏省卫生健康委员会医学科研项目面上项目(2021-166号)
扬州市重点实验室培育专项基金(YZ20211148)。
关键词
呼吸
人工
老年人
衰弱
心脏功能试验
呼吸功能试验
Respiration,artificial
Aged
Frail
Heart function tests
Respiratory function tests
