控制性肺膨胀法辅助腹腔镜胃癌根治术对手术疗效及风险的影响

doi:10.3760/cma.j.issn.1007-1245.2024.01.014

摘要/Abstract

摘要：

目的　观察控制性肺膨胀法（sustained inflation，SI）辅助腹腔镜胃癌根治术对手术疗效及术后风险的影响。方法　选取南阳医学高等专科学校第一附属医院2021年1月至2022年12月收治的112例胃癌患者进行随机对照试验，采用随机数字表法将入组患者分为观察组和对照组，各56例。观察组男30例，女26例，年龄（60.35±5.22）岁；对照组男33例，女23例，年龄（61.23±5.16）岁。所有患者均采用腹腔镜胃癌根治术治疗；对照组实施常规麻醉及机械通气，在对照组基础上观察组采用SI辅助。比较两组患者围手术期血流动力学、围手术期呼吸力学、氧合功能以及术后72 h肺部并发症（pulmonary complications，PPC）发生情况。采用χ²检验和t检验。结果　两组患者气腹建立前（T₀）血流动力学、呼吸力学、氧合功能指标差异均无统计学意义（均P>0.05）；观察组气腹建立10 min后（T₁）心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）分别为（80.52±10.41）次/min、（115.75±20.61）mmHg（1 mmHg=0.133 kPa），气腹建立30 min后（T₂）HR、MAP分别为（82.44±10.36）次/min、（118.45±20.61）mmHg，均低于对照组［（85.25±10.36）次/min、（130.46±20.17）mmHg、（89.25±10.32）次/min、（141.44±20.61）mmHg］，差异均有统计学意义（t=2.410、3.817、3.485、5.903；均P<0.05）。观察组T₁时肺泡-动脉氧分压差（difference of alveoli-arterial oxygen pressure，A-aDO₂）、呼吸指数（respiratory index，RI）分别为（125.77±20.61）mmHg、（35.77±5.28），T₂时A-aDO₂、RI分别为（165.33±30.61）mmHg、（40.12±10.36），均低于对照组［（140.33±20.45）mmHg、（38.46±5.61）、（192.25±30.72）mmHg、（47.62±10.35）］，差异均有统计学意义（t=3.753、2.613、4.645、3.833；均P<0.05）。观察组T₁时气道峰值压力（peak airway pressure，Ppeak）、平均气道压（mean airway pressure，Pmean）分别为（18.44±5.16）mmHg、（6.62±1.77）mmHg，T₂时Ppeak、Pmean分别为（25.61±5.32）mmHg、（7.69±2.45）mmHg，均低于对照组［（21.33±5.62）mmHg、（7.82±2.31）mmHg、（28.45±5.66）mmHg、（8.95±2.21）mmHg］，差异均有统计学意义（t=2.835、3.086、2.736、2.858；均P<0.05）。术后72 h内，观察组PPC发生率为10.71%（6/56），低于对照组的23.21%（13/56），差异有统计学意义（χ²=5.547，P<0.05）。结论　SI辅助胃癌根治术能有效维持患者围手术期血流动力学、呼吸力学及氧合功能稳定，对降低术后PPC发生风险也有重要意义。

关键词:

胃癌根治术, 腹腔镜手术, 控制性肺膨胀法, 呼吸力学, 肺部并发症

Abstract:

Objective　To observe the impact of laparoscopic radical gastrectomy assisted by sustained inflation (SI) on surgical efficacy and postoperative risk. Methods　One hundred and twelve patients with gastric cancer admitted to First Hospital, Nanyang Medical College from January 2021 to December 2022 were selected for the randomized controlled trial. The enrolled patients were divided into an observation group and a control group by the random number table method, with 56 cases in each group. There were 30 males and 26 females in the observation group; they were (60.35±5.22) years old. There were 33 males and 23 females in the control group; they were (61.23±5.16) years old. All the patients took laparoscopic radical gastrectomy. The control group took routine anesthesia and mechanical ventilation; in addition, the observation group were assisted by SI. The perioperative hemodynamics, respiratory mechanics, oxygenation function, and the incidences of pulmonary complications (PPC) 72 h after the surgery were compared between the two groups. χ² and t were used. Results　There were no statistical differences in hemodynamics, respiratory mechanics, and oxygenation function indicators between the two groups before the establishment of pneumoperitoneum (T₀) (all P>0.05). The heart rates (HR) and mean arterial pressures (MAP) 10 (T₁) and 30 min (T₂) after the establishment of pneumoperitoneum in the observation group were (80.52±10.41) times/min, (115.75±20.61) mmHg (1 mmHg=0.133 kPa), (82.44±10.36) times/min, and (118.45±20.61) mmHg, which were lower than those in the control group [(85.25±10.36) times/min, (130.46±20.17) mmHg, (89.25±10.32) times/min, and (141.44±20.61) mmHg], with statistical differences (t=2.410, 3.817, 3.485, and 5.903; all P<0.05). The differences of alveoli-arterial oxygen pressure (A-aDO₂) and respiratory index (RI) at T₁ and T₂ in the observation group were (125.77±20.61) mmHg, (35.77±5.28), (165.33±30.61) mmHg, and (40.12±10.36), which were lower than those in the control group [(140.33±20.45) mmHg, (38.46±5.61), (192.25±30.72) mmHg, and (47.62±10.35)], with statistical differences (t=3.753, 2.613, 4.645, and 3.833; all P<0.05). The peak airway pressures (Ppeak) and mean airway pressures (Pmean) at T₁ and T₂ in the observation group were (18.44±5.16) mmHg, (6.62±1.77) mmHg, (25.61±5.32) mmHg, and (7.69±2.45) mmHg, which were lower than those in the control group [(21.33±5.62) mmHg, (7.82±2.31) mmHg, (28.45±5.66) mmHg, and (8.95±2.21) mmHg], with statistical differences (t=2.835, 3.086, 2.736, and 2.858; all P<0.05). Within 72 h after the surgery, the incidence of PPC in the observation group was lower than that in the control group [10.71% (6/56) vs. 23.21% (13/56)], with a statistical difference (χ²=5.547, P<0.05). Conclusion　Radical gastrectomy assisted by SI for patients with gastric cancer can effectively maintain the stability of perioperative hemodynamics, respiratory mechanics, and oxygenation function, and is also of great significance in reducing the risk of postoperative PPC.

Key words:

Radical gastrectomy for gastric cancer, Laparoscopy, ustained inflation, Respiratory mechanics, Pulmonary complications

王蒙张霜李佳.

控制性肺膨胀法辅助腹腔镜胃癌根治术对手术疗效及风险的影响 [J]. 国际医药卫生导报, 2024, 30(1): 67-71.

Wang Meng, Zhang Shuang, Li Jia .

Effect of laparoscopic radical gastrectomy assisted by sustained inflation on surgical efficacy and risk [J]. International Medicine and Health Guidance News, 2024, 30(1): 67-71.

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