Effect of ERAS + non endotracheal intubation reserved spontaneous respiration on the stress response in elderly patients after laparoscopic general anesthesia surgery

doi:10.3760/cma.j.issn.1007-1245.2023.03.013

Abstract

Abstract:

Objective　To explore the effect of enhanced recovery after surgery (ERAS) + non endotracheal intubation reserved spontaneous respiration on the stress response in elderly patients after laparoscopic general anesthesia surgery. Methods　It was a randomized controlled trial. A total of 86 elderly patients who underwent laparoscopic general anesthesia surgery in Bayannur City Hospital from January 2020 to January 2022 were selected as the study subjects for a prospective study. They were simply randomly divided into an observation group and a control group, with 43 patients in each group. The observation group consisted of 29 males and 14 females; the age was (76.92±6.27) years old; ERAS nursing + non endotracheal intubation reserved spontaneous respiration was used for general anesthesia. The control group consisted of 26 males and 17 females; the age was (75.86±6.93) years old; regular nursing + one lung ventilation with double lumen bronchial intubation was used for general anesthesia. The changes of hemodynamic indexes [heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP)], stress response indexes [C-reactive protein (CRP), cortisol (Cor), and adrenaline (Adr)], arterial oxygen saturation (SaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and anxiety [scores of Hamilton Anxiety Scale (HAMA) and Self-rating Anxiety Scale (SAS)] before and after surgery and postoperative complications were compared between the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　After surgery, the HR [(77.67±7.91) beats/min], SBP [(135.05±9.21) mmHg (1 mmHg=0.133 kPa)], and DBP [(82.01±7.13) mmHg] in the observation group were lower than those in the control group [HR (87.25±8.53) beats/min, SBP (138.94±8.0) mmHg, and DBP (85.48±7.26) mmHg] (all P<0.05). After surgery, the levels of CRP [(73.95±15.29) mg/L], Cor [(113.77±4.25) nmol/L], and Adr [(197.25±6.71) pmol/L] in the observation group were lower than those in the control group [CRP (85.67±16.51) mg/L, Cor (120.51±3.17) nmol/L, and Adr (213.37±7.22) pmol/L] (all P<0.05). After surgery, the SaO₂ of the observation group was lower than that of the control group [(94.25±1.58) % vs. (95.23±2.17) %], and the PaCO₂ of the observation group was higher than that of the control group [(56.96±4.87) p/kPa vs. (46.57±4.21) p/kPa] (both P<0.05). The HAMA score and SAS score of the observation group were lower than those of the control group [(12.67±4.13) vs. (15.93±2.36), (55.38±2.61) vs. (62.07±2.84)] (both P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group [11.63% (5/43) vs. 39.53% (17/43)] (χ²=8.796, P=0.003). Conclusion　ERAS + non endotracheal intubation reserved spontaneous respiration can reduce the stress response in elderly patients after laparoscopic general anesthesia surgery, alleviate the anxiety, and promote the patients' recovery, with a low complication rate, which is recommended for clinical application.

Key words:

Enhanced recovery after surgery, Non endotracheal intubation, Spontaneous respiration, Laparoscopy, General anesthesia, Stress response

摘要：

目的　探讨加速康复外科（ERAS）+非气管插管保留自主呼吸对老年腹腔镜全麻手术患者术后应激反应的影响。方法　本研究为随机对照试验。选择2020年1月至2022年1月在巴彦淖尔市医院进行腹腔镜全麻手术的老年患者86例为研究对象，开展前瞻性研究，简单随机分为观察组和对照组，两组均为43例。观察组男性29例，女性14例，年龄为（76.92±6.27）岁，采用ERAS护理+非气管插管保留自主呼吸全麻；对照组男性26例，女性17例，年龄为（75.86±6.93）岁，采用常规护理+双腔支气管插管单肺通气全麻。比较两组患者手术前后血流动力学指标［心率（HR）、收缩压（SBP）、舒张压（DBP）］、应激反应指标［C反应蛋白（CRP）、皮质醇（Cor）、肾上腺素（Adr）］、动脉血氧饱和度（SaO₂）、动脉血二氧化碳分压（PaCO₂）、焦虑情况［汉密尔顿焦虑量表（HAMA）、焦虑自评量表（SAS）评分］变化以及术后并发症发生情况。计量资料采用t检验，计数资料采用χ²检验。结果　手术后观察组HR（77.67±7.91）次/min、SBP（135.05±9.21）mmHg（1 mmHg=0.133 kPa）、DBP（82.01±7.13）mmHg均低于对照组HR（87.25±8.53）次/min、SBP（138.94±8.0）mmHg、DBP（85.48±7.26）mmHg（均P<0.05）；手术后观察组CRP（73.95±15.29）mg/L、Cor（113.77±4.25）nmol/L、Adr（197.25±6.71）pmol/L均低于对照组CRP（85.67±16.51）mg/L、Cor（120.51±3.17）nmol/L、Adr（213.37±7.22）pmol/L（均P<0.05）；手术后观察组SaO₂（94.25±1.58）%低于对照组SaO₂（95.23±2.17）%，观察组PaCO₂（56.96±4.87）p/kPa高于对照组PaCO₂（46.57±4.21）p/kPa（均P<0.05）；手术后观察组HAMA评分（12.67±4.13）分、SAS评分（55.38±2.61）分均低于对照组HAMA评分（15.93±2.36）分、SAS评分（62.07±2.84）（均P<0.05）；观察组术后并发症发生率11.63%（5/43）显著低于对照组39.53%（17/43）（χ²=8.796，P=0.003）。结论　ERAS+非气管插管保留自主呼吸可减少老年腹腔镜全麻手术患者应激反应，缓解焦虑情况，促进患者恢复且并发症发生率低，推荐临床应用。

关键词:

加速康复外科, 非气管插管, 自主呼吸, 腹腔镜手术, 全麻, 应激反应

Hao Zhi, Rao Kong, Li Shuai.

Effect of ERAS + non endotracheal intubation reserved spontaneous respiration on the stress response in elderly patients after laparoscopic general anesthesia surgery [J]. International Medicine and Health Guidance News, 2023, 29(3): 356-360.

郝智饶孔李帅.

ERAS+非气管插管保留自主呼吸对老年腹腔镜全麻手术患者术后应激反应的影响 [J]. 国际医药卫生导报, 2023, 29(3): 356-360.

References

[1] Lee JH, Choi JY, Kim YJ. Safety of laparoscopic surgery during pregnancy: a Korean nationwide population-based study[J]. Surg Endosc, 2022, 36(10):7529-7540. DOI: 10.1007/s00464-022-09188-9.
[2] 鲁素红,冯艺.复方利多卡因乳膏在双腔气管插管全身麻醉胸腔镜肺叶切除术中的应用——前瞻性随机对照研究[J].中国微创外科杂志,2019,19(3):197-201. DOI:10.3969/j.issn.1009-6604.2019.03.002.
[3] 程成,刘怡婷,陈飞宇,等.自主呼吸非气管插管胸腔镜手术的研究进展[J].解放军医学杂志,2019,44(5):440-445. DOI:10.11855/j.issn.0577-7402.2019.05.14.
[4] 曾玉婷,李芳,时刘敏,等.老年患者术后肺部并发症早期识别及护理干预研究进展[J].中华护理杂志,2019,54(7):1102-1107. DOI:10.3761/j.issn.0254-1769.2019.07.029.
[5] Xu L, Li X, Song M, et al. Clinical application of accelerated rehabilitation surgery in elderly patients with colorectal cancer[J]. Medicine (Baltimore), 2020, 99(41):e22503. DOI: 10.1097/MD.0000000000022503.
[6] Reuter S, Woelber L, Trepte CC, et al. The impact of Enhanced Recovery after Surgery (ERAS) pathways with regard to perioperative outcome in patients with ovarian cancer[J]. Arch Gynecol Obstet, 2022, 306(1):199-207. DOI: 10.1007/s00404-021-06339-6.
[7] 孙亚林,孙莉,李廷坤,等.不同气管插管术在胸腹腔镜食管癌根治术中的应用[J].中华医学杂志,2021,101(9):630-635. DOI:10.3760/cma.j.cn112137-20200628- 01963.
[8] Liang H, Liu J, Wu S, et al. Nonintubated spontaneous ventilation offers better short-term outcome for mediastinal tumor surgery[J]. Ann Thorac Surg, 2019, 108(4):1045-1051. DOI: 10.1016/j.athoracsur.2019. 04.052.
[9] 赵伟,付海涛,尉景兰,等.快速康复外科护理策略对高龄肥胖女性腔镜子宫切除术手术应激和术后康复的影响[J].广东医学,2019,40(17):2483-2486. DOI:10.13820/j.cnki.gdyx.20190032.
[10] 李燕君.循证护理在表柔比星联合替加氟治疗胃癌中应用及对患者血流动力学影响[J].中华肿瘤防治杂志,2019,26(S1):204,206.
[11] 刘鲲鹏,王宝宁,申琰琰,等.胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响[J].北京大学学报(医学版),2019,51(4):742-747. DOI:10.19723/j.issn.1671-167X.2019.04.026.
[12] Catarci M, Ruffo G, Viola MG, et al. ERAS program adherence-institutionalization, major morbidity and anastomotic leakage after elective colorectal surgery: the iCral2 multicenter prospective study[J]. Surg Endosc, 2022, 36(6):3965-3984. DOI: 10.1007/s00464-021- 08717-2.
[13] 宋兴超,路要武,吴超,等.ERAS对全腹腔镜远端胃癌D2根治术患者应激反应、生命体征及细胞免疫的影响[J].中国普通外科杂志,2020,28(8):1031-1036. DOI:10.7659/j.issn.1005-6947.2019.08.019.
[14] 孙德峰.加速术后康复理念下术后镇痛管理策略[J].实用医学杂志,2022,38(17):2123-2127. DOI:10.3969/j.issn.1006-5725.2022.17.002.
[15] Kelliher LJS, Scott M. Modifying the stress response - perioperative considerations and controversies[J]. Anesthesiol Clin, 2022, 40(1):23-33. DOI: 10.1016/j.anclin.2021.11.012.
[16] 张冉,徐国亭.硬膜外麻醉联合全麻在老年结直肠癌患者腹腔镜手术中的应用价值[J].国际医药卫生导报,2022,28(14):1982-1985. DOI:10.3760/cma.j.issn.1007-1245. 2022.14.013.
[17] 徐青荣,沈江,吴月红,等.胸腔镜肺大泡切除术非气管插管与传统全身麻醉方法比较[J].实用医学杂志,2019,35(3):420-423. DOI:10.3969/j.issn.1006-5725.2019.03.019.
[18] 朱莹,高巨,陈小萍,等.全麻诱导期不同FiO2对妇科腹腔镜手术患者围术期肺功能的影响[J].中华麻醉学杂志,2021,41(7):789-792. DOI:10.3760/cma.j.cn131073.20210131. 00706.
[19] 岳耀存,隋炎炎,孙立新.胸椎旁神经阻滞与硬膜外麻醉对非气管插管肺叶切除术患者镇痛和免疫的影响[J].中国现代医学杂志,2020,30(22):25-30. DOI:10.3969/j.issn.1005-8982.2020.22.005.