不同吸入氧浓度对老年患者腹腔镜前列腺癌根治术后早期肺功能的影响

Effect of different fraction of inspiration oxygen on early pulmonary function after laparoscopic radical prostatectomy for prostate cancer in elderly patients

中文关键词: 吸入氧浓度  电阻抗断层成像  老年  前列腺癌  肺功能

英文关键词: Fraction of inspiration oxygen  Electrical impedance tomography  Aged  Prostate cancer  Lung function

中文摘要:

      
目的： 比较术中吸入氧浓度（FiO₂）30%和80%对老年患者腹腔镜前列腺癌根治术后肺功能的影响。
方法： 选择择期行腹腔镜前列腺癌根治术的老年患者60例，年龄≥65岁，BMI 18～30 kg/m²，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：FiO₂ 30%组（L组）和FiO₂ 80%组（H组），每组30例。气管插管后行肺复张，L组调整FiO₂为30%直至拔除气管导管。H组调整FiO₂为80%直至拔除气管导管。记录入室后5 min（T₀）、手术开始后1 h（T₁）、手术开始后2 h（T₂）、拔管后30 min（T₃）的HR、MAP，并行动脉血气分析记录PaO₂、PaCO₂，计算氧合指数（OI）。于T₀、T₃时行电阻抗断层成像（EIT）监测，评估肺通气功能，记录中心通气区（CoV）、依赖静止区（DSS）、非依赖静止区（NSS）的面积百分比。术前1 d、术后第1、3、5天测定第1秒用力呼气容积（FEV₁）、用力肺活量（FVC）、1秒率（FEV₁/FVC）。记录术后5 d内肺不张、呼吸道感染和胸腔积液等肺部并发症的发生情况。
结果： 与H组比较，L组T₃时DSS面积百分比明显降低（P＜0.05），PaO₂与OI明显升高（P＜0.05），术后第1天FVC、FEV₁和FEV₁/FVC均明显升高（P＜0.05），术后第3天FEV₁/FVC明显升高（P＜0.05），术后5 d内肺不张发生率明显降低（P＜0.05）。
结论： 与FiO₂ 80%比较，术中FiO₂ 30%可以明显改善老年患者腹腔镜前列腺癌根治术后30 min肺通气、氧合功能与术后早期的肺功能，减少术后肺不张的发生。

英文摘要:

      
Objective: To investigate the effects of intraoperative fraction of inspiration oxygen (FiO₂) 30% and 80% on pulmonary function after laparoscopic radical prostatectomy for prostate cancer in elderly patients.
Methods: Sixty elderly patients, aged ≥ 65 years, BMI 18-30 kg/m², ASA physical status Ⅱ or Ⅲ, underwent elective laparoscopic radical prostatectomy for prostate cancer were selected. The patients were divided into two groups: the FiO₂ 30% group (group L) and the FiO₂ 80% group (group H), 30 patients in each group. After tracheal intubation, the patients were manoeuvred, and inhaled oxygen concentration was adjusted by 30% until the removal of the tracheal tube in group L. In group H, inhaled oxygen concentration was adjusted by 80% until the removal of the tracheal tube. HR and MAP were recorded 5 minutes after admission (T₀), 1 hour after the start of surgery (T₁), 2 hours after the start of surgery (T₂), and 30 minutes after extubation (T₃), arterial blood gas analysis was performed to record PaO₂ and PaCO₂, and the oxygenation index (OI) was calculated. Electrical impedance tomography (EIT) monitoring was performed at T₀ and T₃ to assess the pulmonary ventilation function, and the percentage of the area of the central ventilation zone (CoV), dependent static zone (DSS), and non-dependent static zone (NSS) were recorded. Exertional expiratory volume in the first second (forecd expirtory volume in the first second, FEV₁), exertional lung capacity (forecdvital cipitory, FVC), and 1-second rate (FEV₁/FVC) were measured on preoperative day 1, postoperative day 1, postoperative day 3 and postoperative day 5. The occurrence of pulmonary complications such as atelectasis, respiratory infection, and pleural effusion within 5 days postoperatively were recorded.
Results: Compared with group H, the percentage of DSS area at T₃ was significantly decreased (P < 0.05), PaO₂ and OI were significantly increased (P < 0.05), FVC, FEV₁, and FEV₁/FVC on postoperative day 1 were significantly increased (P < 0.05), FEV₁/FVC on postoperative day 3 was significantly increased (P < 0.05), the incidence of cumulative pulmonary atelectasis was significantly decreased in group L within 5 days postoperatively (P < 0.05).
Conclusion: Compared with FiO₂ 80%, FiO₂ 30% intraoperatively significantly improves pulmonary ventilation and oxygenation 30 minutes after laparoscopic radical prostatectomy with early postoperative lung function in elderly patients, and reduces postoperative pulmonary atelectasis.