肺保护通气对食管癌患者术后肺部并发症的影响

目的探究肺保护通气对食管癌患者术后肺部并发症的影响。方法选取2014年1月-2017年1月该院收治的98例胸腹腔镜食管癌根治手术患者为研究对象,将患者依据随机数表法分为观察组(n=49)和对照组(n=49),两组患者术中均行单腔气管导管辅以二氧化碳CO2人工气胸,对照组患者采用传统通气模式,观察组患者采用肺保护性通气策略,比较两组患者不同时间点[气管插管后10 min(T_1);单肺通气1 h(T_2);手术结束时(T_3);术后24 h(T_4)]的肺功能指标、炎症反应、血气分析。依据患者术后是否复发肺部并发症分为复发组(n=24)和非复发组(n=74),分析肺部并发症及其相关因素。结果两组患者T_1时刻的吸气平台压(Pplat)、气道峰压(Ppeak)、气道阻力(Raw)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、可溶性细胞间黏附分子(Sicam-1)、二氧化碳分压(PaCO_2)、血氧分压(PaO_2)和氧合指数(PaO_2/FiO_2)差异无统计学意义(P0.05);T_1~T_3之间对照组患者Pplat、Ppeak和Raw的变化幅度明显大于观察组患者,差异有统计学意义(P0.05),T_1~T_4之间对照组患者IL-6、IL-8和Sicam-1的变化幅度明显大于观察组患者,差异有统计学意义(P0.05),T_1~T_4之间对照组患者PaO_2的变化幅度明显大于观察组患者,差异有统计学意义(P0.05)。两组患者中均有部分患者存在多个肺部并发症,观察组和对照组分别有18.36%和30.61%患者合并各类肺部并发症,差异有统计学意义(P0.05)。术前吸烟、手术时间、根治程度、临床病理分期、淋巴管浸润、微血管浸润和术后辅助化疗与食管癌根治手术患者肺部并发症有密切相关性(P0.05)。结论肺保护通气能够缓解胸腹腔镜食管癌根治手术中气道阻力、压力和炎症反应,增大氧饱和度,应加强对高危肺部并发症发生率患者的监控,进行针对性预防,降低术后肺部并发症的发生率。

Effect of lung protection ventilation on postoperative lung complications in patients with esophageal cancer

Abstract: Objective To investigate the effect of lung protection ventilation on postoperative pulmonary complications in patients with esophageal cancer. Methods 98 patients underwent thoracoscopic laparoscopic esophagectomy for radical resection from January 2014 to January 2017 were enrolled in this study. Patients were divided into observation group (n = 49) and control group (n = 49) randomly. Two groups of patients underwent intraoperative single lumen tracheal catheter supplemented with CO2 pneumothorax. The control group received conventional ventilation. The protective group of patients in the observation group were given protective ventilation. The time of tracheal intubation after 10 min (T1); single lung ventilation 1 h (T2); at the end of surgery (T3); 24 h (T4) after pulmonary function parameters, inflammatory response, blood gas were analyzed. The patients were divided into recurrence group (n = 24) and non-recurrence group (n = 74), pulmonary complications and its related factors were analyzed according to whether the patient had recurrent or not pulmonary complications after recurrent (n = 24) or non-recurrent (n = 74). Results Pplat, airway peak pressure (Ppeak), airway resistance (Raw), interleukin-6 (IL-6), and interleukin-8 (in the two groups) at time T1. Interleukin-8, (IL-8), soluble intercellular adhesion molecule-1 (Sicam-1), partial pressure of carbon dioxide in artery (PaCO2), partial pressure of oxygen There was no significant difference in the index of oxygen, PaO2, and oxygenation index (PaO2/FiO2) (P > 0.05); the changes in Pplat, Ppeak, and Raw in the control group between T1 and T3 were significantly greater than those in the observation group. The changes of IL-6, IL-8, and Sicam-1 in the control group from T1 to T4 were significantly greater than those in the observation group (P < 0.05). T1 to T4 The change of PaO2 in the control group was significantly greater than that in the observation group, and the difference was statistically significant (P < 0.05). There were multiple pulmonary complications in some patients in both groups. There were 18.36% in the observation group and 30.61% in the control group combined with various types of pulmonary complications. The difference was statistically significant (P < 0.05). Preoperative smoking, operation time, degree of radicalization, clinical pathological stage, lymphatic infiltration, microvascular infiltration, postoperative adjuvant chemotherapy, and pulmonary complications in patients undergoing radical surgery for esophageal cancer were closely related (P < 0.05). Conclusion Lung protection ventilation can relieve the thoracoscopic laryngeal esophageal cancer surgery in the airway resistance, pressure and inflammation, increased oxygen saturation, should strengthen the high risk of pulmonary complications in patients with monitoring, targeted prevention, reduce postoperative the incidence of pulmonary complications.