非通气侧肺持续中低流量给氧...年胸腔镜肺癌根治术中的应用_黄俊萍.pdf

doi:1011659/jjssx08E022109临床研究非通气侧肺持续中低流量给氧在老年胸腔镜肺癌根治术中的应用黄俊萍1，周颖2，闭玉华1(1 广西医科大学附属武鸣医院麻醉手术科，广西 南宁 530199;2 玉林市红十字会医院麻醉科，广西 玉林 537000)摘要 目的探讨非通气侧肺持续中低流量给氧在老年胸腔镜肺癌根治术中的临床应用效果。方法选择广西医科大学附属武鸣医院接受胸腔镜治疗的老年肺癌患者 80 例，按照随机数字表法将其分为观察组和对照组，每组 40 例。观察组单肺通气过程中非通气侧肺持续中低流量给氧，对照组非通气侧肺未进行特殊给氧。比较 2 组单肺通气过程中丙二醛(MDA)、超氧化物歧化酶(SOD)、超敏 C 反应蛋白(hs-CP)等氧化应激与炎症指标。比较 2 组麻醉前、单肺通气时、干预 15 min 时、给氧干预 1 h 时及停止单肺通气时动脉血氧分压变化情况。比较 2 组单肺通气过程中气道平台压(Pplat)、气道峰压(Ppeak)及肺顺应性 Cldyn20水平。统计 2 组麻醉苏醒相关指标和围术期呼吸相关并发症发生情况。结果单肺通气过程中，观察组 SOD 水平高于对照组(P 0 05)，MDA、hs-CP 水平低于对照组(P 0 05)，观察组干预15 min 时、给氧干预1 h 时及停止单肺通气时动脉血氧分压均高于对照组(P 0 05)。单肺通气过程中观察组 Pplat、Ppeak 低于对照组(P 0 05)，Cldyn20 水平高于对照组(P 0 05)。观察组呼吸恢复时间、意识恢复时间、拔管时间和复苏室停留总时间均显著短于对照组(P 0 05)，肺不张、低氧血症、气胸和复张性肺水肿等围术期呼吸相关并发症的总发生率显著低于对照组(P 0 05)。结论老年胸腔镜肺癌根治术患者实施非通气侧肺组织持续中低流量给氧，能有效降低机体炎症应激反应，增加动脉血氧分压，改善肺通气功能与顺应性，促进麻醉复苏，且可显著减少呼吸相关并发症的发生。关键词非通气侧肺;持续中低流量给氧;单肺通气;胸腔镜;肺癌根治术 中图分类号734 2 文献标识码A 收稿日期2022-08-18 基金项目广西壮族自治区卫生健康委自筹课题(Z20210428)通信作者闭玉华，E-mail:116906145 qq comApplication of continuous medium and low flow oxygen supply to non-ventilated lung in elderly thoracoscopicradical resection of lung cancerHUANG Jun-ping1，ZHOU Ying2，BI Yu-hua1(1 Department of Anesthesiology and Surgery，Wuming Hospital of Guangxi MedicalUniversity，Nanning Guangxi 530199，China;2 Department of Anesthesiology，Yulin ed Cross Hospital，Yulin Guangxi 537000，China)Abstract:ObjectiveTo explore the clinical application effect of continuous medium and low flow oxygen supply to non-ventilated lungin elder patients undergoing thoracoscopic radical resection of lung cancer MethodsA total of 80 elderly patients with lung cancer treatedby thoracoscopy in Wuming Hospital of Guangxi Medical University were selected and divided into the observation group and the control groupaccording to the random number table method，with 40 cases in each group Patients in the observation group were given continuous mediumand low flow oxygen supply to non-ventilated lung during one-lung ventilation，while no special oxygen was given to the non-ventilated lung forpatients in the control group The levels of oxidative stress and inflammatory indexes such as malondialdehyde(MDA)，superoxide dismutase(SOD)and hypersensitivity-C reactive protein(hs-CP)during one-lung ventilation between the two groups were compared The changes ofarterial oxygen partial pressure before anesthesia，during one-lung ventilation，after intervention for 15 minutes，after giving oxygen interventionfor 1 hour and after stopping one-lung ventilation between the two groups were compared The airway plateau pressure(Pplat)，peak pressure(Ppeak)and lung compliance Cldyn20 level during one-lung ventilation between the two groups were compared The related indexes of anes-thesia recovery and the occurrence of perioperative respiration related complications between the two groups were counted esultsDuringone-lung ventilation，the SOD level of the observation group was higher than that of the control group(P 0 05)，the levels of MDA andhs-CP were lower than those in the control group(P 0 05)The arterial oxygen partial pressures after intervention for 15 minutes，aftergiving oxygen intervention for 1 hour and after stopping one-lung ventilation in the observation group were higher than those in the controlgroup(P 0 05)During one-lung ventilation，the Pplat and Ppeak of the observation group were lower than those of the control group(P 0 05)，and the Cldyn20 level was higher than that of the control group(P 0 05)The time of respiration recovery，consciousnessrecovery，extubation and the total stay in the resuscitation room in the observation group were significantly shorter than those in the controlgroup(P 0 05)The total incidence of perioperative respiratory-related complications including atelectasis，hypoxemia，pneumothorax and262局解手术学杂志J EG ANAT OPE SUG2023，32(3)http:/www jjssxzz cnreexpansion pulmonary edema in the observation group was significantly lower than that in the control group(P 0 05)ConclusionInelder patients undergoing thoracoscopic radical resection of lung cancer，continuous medium and low flow oxygen supply to non-ventilated lungtissue can effectively reduce body inflammation and stress reaction，increase the arterial oxygen partial pressure，improve the pulmonaryventilation function and compliance，promote the anesthesia recovery，and significantly reduce the respiration related complicationsKeywords:non-ventilated lung;continuous medium and low flow oxygen supply;one-lung ventilation;thoracoscope;radical resection oflung cancer随着微创技术在临床中的应用，肺癌根治术多经胸腔镜治疗，且麻醉要求双腔气管插管术中实施单肺通气，以确保术侧肺组织塌陷，避免因呼吸通气动作影响手术操作1。然而单肺通气是一种非生理性呼吸模式，通气血流比会发生明显改变。研究证实，单肺通气时间超过 60 min 将导致术中低氧血症、肺不张、呼吸机相关性肺损伤甚至急性呼吸窘迫综合征的发生，严重影响患者的预后，尤其是老年患者，其单肺通气过程中非通气侧肺的萎陷与肺复张可能导致缺氧 复氧性肺损伤及氧化应激反应等，进一步加重肺组织损伤2。单肺通气过程中非通气侧肺虽无氧合作用，但血流尚未阻断，肺内分流显著增加，随着单肺通气时间的延长，肺泡 动脉血氧分压差较正常的双肺通气过程明显增高，进一步降低动脉血氧分压3。对老年单肺通气患者非通气侧肺组织持续中低流量给氧，并不会增加非通气侧肺气道压，且无肺组织扩张效应，对术野无影响4，还能有效改善非通气侧肺通气血流比，避免低氧血症、肺不张及炎症应激反应等的发生。但是，该技术方法在开胸双腔管置入术中的应用较少，尤其是针对老年患者极少有文献报道，其安全性和有效性有待更多研究证实。因此，本研究主要探讨老年胸腔镜肺癌根治术麻