摘要： 目的 探讨亚高原地区腹腔镜手术全身麻醉期间吸入不同浓度氧气对围术期呼吸功能的影响。方法 选择2020年12月至2021年8月西宁市大通回族土族自治县人民医院外科择期行全身麻醉下腹腔镜胆囊切除术患者60例，按照全身麻醉期间吸入氧浓度不同随机均分为3组：A组（吸入100%氧，n=20）、B组（吸入80%氧，n=20）、C组（吸入60%氧，n=20）。比较3组麻醉诱导前（T0）、气管插管后5 min （T1）、气腹30 min （T2）、关气腹（T3）、术后1 d （T4）的气道峰压（Ppeak）、气道平台压（Pplat）、肺动态顺应性（Cdyn）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、氧合指数（OI）等临床指标。比较3组术后肺部并发症、术后切口感染和胃肠道首次排气时间。结果 与T1比较，各组T2时Ppeak和Pplat均增高（P < 0.05），Cdyn均降低（P < 0.05） ；A组在T3时Cdyn仍降低（P < 0.05）。与A组同时间点比较，T2和T3时B组和C组Ppeak降低（P < 0.05） ；C组Pplat降低，Cdyn增高（P < 0.05）。与T0比较，A组和B组T4时PaO₂降低（P < 0.05），而C组T4时PaO₂无统计学差异（P > 0.05） ； T2时各组OI均降低（P < 0.05） ； A组和B组T4时OI降低（P < 0.05），而C组T4时OI无统计学差异（P > 0.05）。与A组同时间点比较，C组T2时PaO₂降低（P < 0.05），而B组T2时PaO₂无统计学差异（P > 0.05） ； B组和C组T4时PaO₂增高（P < 0.05），且C组高于B组（P < 0.05）。与A组同时间点比较，B组和C组T2、T4时OI均增高（均P < 0.05），且C组均高于B组（均P < 0.05）。3组患者均未发生术后切口感染，术后肺部并发症和胃肠道首次排气时间比较均无统计学差异（均P > 0.05）。结论 亚高原地区腹腔镜手术患者全身麻醉期间吸入60%氧安全有效，可显著改善围术期患者的呼吸功能。

亚高原地区腹腔镜手术患者全身麻醉期间吸入不同浓度氧气对围术期呼吸功能的影响

韩继元¹, 怀立春¹, 吴成璋², 程启芳¹, 李玉珍¹, 方波^1,3

1. 西宁市大通回族土族自治县人民医院麻醉科, 西宁 810100;
2. 西宁市大通回族土族自治县人民医院外二科, 西宁 810100;
3. 中国医科大学附属第一医院麻醉科, 沈阳 110001

收稿日期:2021-09-26出版日期:2022-02-28发布日期:2022-01-05
通讯作者:方波E-mail:drunk0630@126.com
作者简介:韩继元(1986-),男,主治医师,本科.
基金资助:辽宁省自然科学基金（2019-ZD-0742）


关键词: 亚高原地区, 腹腔镜手术, 全身麻醉, 吸入氧浓度, 呼吸功能
Abstract: Objective To investigate the effects of different fractions of inspired oxygen on perioperative respiratory function in laparoscopic surgery during general anesthesia in the sub-plateau region. Methods Sixty patients with elective laparoscopic cholecystectomy under general anesthesia were selected from December 2020 to August 2021 in the Department of Surgery, People's Hospital of Datong Hui and Tu Autonomous County, Xining city and scheduled for were randomly divided into three groups:patients in group A inhaled 100% oxygen (n=20) during general anesthesia, patients in group B inhaled 80% oxygen (n=20), and patients in group C inhaled 60% oxygen (n=20). Peak airway pressure (Ppeak), plateau airway pressure (Pplat), pulmonary dynamic compliance (Cdyn), arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and oxygenation index (OI) were compared among the three groups before induction of anesthesia (T0), 5 min after endotracheal intubation (T1), 30 min after pneumoperitoneum (T2), ceasing pneumoperitoneum (T3), and 1 day after the operation (T4). Postoperative pulmonary complications, postoperative incision infection, and the time of first gastrointestinal exhaust were compared. Results Compared to T1, Ppeak and Pplat in the T2 group were increased (P < 0.05), and Cdyn in the T2 group was decreased (P < 0.05). Cdyn in group A was still decreased at T3 (P < 0.05). Compared to group A at the same time, Ppeak decreased in groups B and C at T2 and T3 (P < 0.05), Pplat decreased and Cdyn increased in group C (P < 0.05). Compared to T0, PaO₂ in groups A and B at T4 decreased (P < 0.05). At T2, the OI in all groups decreased (P < 0.05), and at T4, the OI in groups A and B still decreased (P < 0.05). Compared to group A at the same time, PaO₂ in group C at T2 was decreased (P < 0.05). The PaO₂ in groups B and C at T4 was higher than that in group A (P < 0.05), and that in group C was higher than that in group B (P < 0.05). Compared to group A at the same time, the OI in groups B and C increased at T2 (P < 0.05), and OI in group C was higher than that in group B (P < 0.05). The OI in groups B and C at T4 was higher than that in group A (P < 0.05), and OI in group C was higher than that in group B (P < 0.05). No postoperative incision infection occurred in the three groups, and there was no significant difference in postoperative pulmonary complications and first gastrointestinal exhaust time among the three groups. Conclusion A 60% inhalation oxygen concentration during general anesthesia in laparoscopic surgery can safely and effectively improve perioperative respiratory function of patients in the sub-plateau.
Key words: sub-plateau region, laparoscopic surgery, general anesthesia, inhaled oxygen concentration, respiratory function
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