CAJ | 학술논문

目的：探讨气腹对老年人肺顺应性和肺内分流率的影响。方法 ASAⅠ～Ⅱ级老年结直肠癌患者46例，按住院号单双随机分为观察组（气腹组）和对照组（开腹组），每组23例。两组患者均采用气管内插管全麻，气管插管后均采用纯氧间歇正压通气。分别于术前（ T0）和手术开始后30 min （ T1）、60 min （ T2）、120 min（T3）、术毕后30 min（T4）测定气道峰压（Ppeak）和气道平台压（Pplat），计算肺顺应性（CL），并于上述时间点抽取桡动脉和中心静脉血作血气分析，计算各时点肺内分流率（ QS／QT）。结果观察组T1、T2、T3时间点Ppeak、Pplat值明显高于对照组同一时间点（P＜0．01），T1、T2、T3时间点CL值明显低于对照组同一时间点（P＜0．01）；观察组T1、T2、T3、T4时间点QS／QT值明显大于对照组同一时间点（P＜0．01）。结论老年人腹腔镜结直肠癌根治术中气腹对肺顺应性和肺内分流率产生明显影响，术中及复苏期均需加强呼吸管理。
목적：탐토기복대노년인폐순응성화폐내분류솔적영향。방법 ASAⅠ～Ⅱ급노년결직장암환자46례，안주원호단쌍수궤분위관찰조（기복조）화대조조（개복조），매조23례。량조환자균채용기관내삽관전마，기관삽관후균채용순양간헐정압통기。분별우술전（ T0）화수술개시후30 min （ T1）、60 min （ T2）、120 min（T3）、술필후30 min（T4）측정기도봉압（Ppeak）화기도평태압（Pplat），계산폐순응성（CL），병우상술시간점추취뇨동맥화중심정맥혈작혈기분석，계산각시점폐내분류솔（ QS／QT）。결과관찰조T1、T2、T3시간점Ppeak、Pplat치명현고우대조조동일시간점（P＜0．01），T1、T2、T3시간점CL치명현저우대조조동일시간점（P＜0．01）；관찰조T1、T2、T3、T4시간점QS／QT치명현대우대조조동일시간점（P＜0．01）。결론노년인복강경결직장암근치술중기복대폐순응성화폐내분류솔산생명현영향，술중급복소기균수가강호흡관리。
Objective To investigate the effects of pneumoperitoneum on senile pulmonary compliance and intrapulmonary shunt.Methods Forty-six elderly patients with ASAⅠ-Ⅱcolorectal cancer were randomly divided into observation group (laparoscopic group) and control group(open group) according to their admission number,with 23 cases in each group.The patients in two groups received endotracheal intubation anesthesia which was followed by pure oxygen intermittent positive pressure ventilation(IPPV).Peak airway pressure(Ppeak) and airway plateau pressure (Pplat) were determined at 5 time points,respectively,preoperative(T0),the 30th(T1),60th(T2) and 120th minute(T3) during surgery,and 30 minutes(T4) after surgery.And then lung compliance(CL) was calculated.Blood samples were collected from radial artery and central venous at the 5 time points,respectively,for a blood gas analysis.Intrapulmonary shunt fraction(QS/QT) of each time point was calculated.Results The Ppeak and Pplat values at T1 ,T2 ,T3 of observation group were significantly higher than those of control group(P<0.01).The CL values at T1,T2,T3 of observation group were significantly lower than those of control group(P<0.01).The QS/QT values at T1 ,T2 ,T3 ,T4 of observation group were significantly higher than those of control group(P<0.01).Conclusion Pneumoperitoneum occurs in the laparoscopic resection has a significant effect on lung compliance and intrapulmonary shunt among elderly patients with colorectal cancer .It is necessary to strengthen the respiration management during operation and recovery period .