摘要
目的 观察熵指数联合保护性肺通气对老年腹腔镜结肠癌根治术患者肺功能、血流动力学及血气指标的影响.方法 以回顾性分析为法,观察对象为2020年10月至2023年2月山西白求恩医院入院的70例老年腹腔镜结肠癌根治术患者,参考治疗方式不同分为常规组(n=23)、保护组(n=23)和联合组(n=24).常规组给予常规肺通气治疗,保护组给予保护性肺通气治疗,联合组给予熵指数联合保护性肺通气治疗.比较3组患者不同时间段[气管插管后(T0)、气腹后30 min(T1)、气腹后1.5 h(T2)、气腹停止后10 min(T3)]的肺功能指标(呼吸指数、氧合指数)、血流动力学指标[平均动脉压(MAP)、心率]、血气指标[动脉血二氧化碳分压(PCO2)、动脉血氧分压(PaO2)]、呼吸力学指标[肺顺应性(CL)、气道峰压(Ppeak)、平均气道压(Pmean)]与术中麻醉药用量(罗库溴铵、舒芬太尼)、术后苏醒时间、拔管时间、呼吸恢复时间及并发症(呼吸衰竭、肺栓塞、肺不张、低氧血症)发生率.结果 3组患者T1、T2、T3的呼吸指数、氧合指数、MAP、PaO2、Ppeak、Pmean均明显高于T0,T1、T2、T3的CL明显低于T0,差异均有统计学意义(P＜0.05);保护组、联合组T1、T2、T3的呼吸指数、氧合指数、PaO2、CL均明显高于常规组,Ppeak、Pmean均明显低于常规组,差异均有统计学意义(P＜0.05);且联合组T1、T2、T3的呼吸指数、氧合指数、PaO2、CL均明显高于保护组,Ppeak、Pmean均明显低于保护组,差异均有统计学意义(P＜0.05).3组患者心率、PCO2组间、组内比较,差异均无统计学意义(P＞0.05).保护组、联合组患者麻醉药用量明显少于常规组,苏醒、拔管及呼吸恢复时间均明显短于常规组,差异均有统计学意义(P＜0.05);且联合组患者麻醉药用量明显少于保护组,苏醒、拔管及呼吸恢复时间均明显短于保护组,差异均有统计学意义(P＜0.05).保护组、联合组的麻醉药用量明显少于常规组,苏醒、拔管及呼吸恢复时间均明显短于常规组,并发症发生率明显低于常规组,差异有统计学意义(P＜0.05),保护组、联合组比较差异有统计学意义(P＜0.05).保护组、联合组患者总并发症发生率分别为17.39％、0,明显低于常规组(47.83％),且联合组患者并发症发生率明显低于保护组,差异均有统计学意义(P＜0.05).结论 熵指数联合保护性肺通气用于老年腹腔镜结肠癌根治术中的临床效果显著,可改善患者肺功能、血气及呼吸力学,还可减少麻醉药用量,缩短患者苏醒、拔管及呼吸恢复时间,且并发症少,安全性高.
Abstract
Objective To observe the effect of entropy index combined with protective lung ventilation on lung function,hemodynamics and blood gas indexes in elderly patients undergoing laparoscopic radical operation for colon cancer.Methods In retrospective analysis,70 elder-ly patients with laparoscopic radical resection of colon cancer admitted to Shanxi Bethune Hospital from March 2020 to October 2023 were ob-served.The patients were divided into the conventional group(n=23),the protection group(n=23)and the combination group(n=24).The conventional group received conventional lung ventilation therapy,the protection group received protective lung ventilation therapy,the combi-nation group received entropy index combined with protective lung ventilation.The pulmonary function indexes(respiratory index,oxygenation in-dex),hemodynamic indexes[mean arterial pressure(MAP),heart rate],blood gas indexes[partial arterial carbon dioxide pressure(PCO2),partial arterial oxygen pressure(PaO2)],respiratory mechanics indexes[lung compliance(CL),airway peak pressure(Ppeak),average airway pressure(Pmean)]at different time periods[after tracheal intubation(T0),30 minutes after pneumoperitoneum(T1),1.5 hours after pneumo-peritoneum(T2),and 10 minutes after pneumoperitoneum cessation(T3)]and postoperative anesthetic dosage,recovery time,extubation time,respiratory recovery time,and incidence of complications(respiratory failure,pulmonary embolism,atelectasis,hypoxemia)were compared among the three groups.Results The respiratory index,oxygenation index,MAP,PaO2,Ppeak,and Pmean of T1,T2,and T3 patients among the three groups were significantly higher than T0,while the CL of T1,T2,and T3 was significantly lower than T0,the differences were statistically significant(P＜0.05).The respiratory index,oxygenation index,PaO2,and CL of T1,T2,and T3 in the protection group and combination group were significantly higher than those in the conventional group,while Ppeak and Pmean were significantly lower than those in the conventional group,the differences were statistically significant(P＜0.05);the respiratory index,oxygenation index,PaO2,and CL of T1,T2,and T3 in the combined group were significantly higher than those in the protection group,while Ppeak and Pmean in the combined group were significantly lower than those in the protection group,the differences were statistically significant(P＜0.05).There were no statistically significant differ-ences in heart rate,PCO2 between groups,or within groups among the three groups of patients(P＞0.05).The anesthesia dosage of patients in the protection group and the combination group was significantly lower than that in the conventional group,and the recovery time for awakening,extubation,and breathing were significantly shorter than those in the conventional group,the differences were statistically significant(P＜0.05);moreover,the dosage of anesthesia in the combination group was significantly lower than that in the protection group,and the awakening,extuba-tion,and respiratory recovery times were significantly shorter than those in the protection group,the differences were statistically significant(P＜0.05).The total incidence of complications in patients in the protection group and the combination group was 17.39％and 0,respectively,which was significantly lower than that in the control group(47.83％),and the incidence of complications in patients in the combination group was sig-nificantly lower than that in the protection group,the differences were statistically significant(P＜0.05).Conclusion The effect of entropy in-dex combined with protective lung ventilation on laparoscopic radical operation of colon cancer in elderly patients is significant,which can signifi-cantly enhance the anesthetic effect,improve lung function,blood gas and respiratory mechanics,reduce anesthetic dosage,shorten the time of re-covery,extubation and respiratory recovery of patients,with fewer complications and high safety.
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