不同吸入氧浓度联合PCV-VG模式对行腹腔镜膀胱癌根治术的老年患者氧合及肺损伤的影响

摘要 目的：探讨不同吸入氧浓度联合压力控制容量保证通气模式(PCV-VG)对行腹腔镜膀胱癌根治术的老年患者氧合及肺损伤的影响。方法：选择2022年3月至2023年3月在我院拟行全身麻醉下腹腔镜膀胱癌根治术的90例老年膀胱癌患者为研究对象，随机分为A组、B组和C组，各30例。所有患者在PCV-VG模式维持机械通气，其中A组、B组、C组的吸入氧浓度分别为40 %、50 %、60 %。检测所有患者通气前（T0）、通气后1 h、2 h和3h（T1-3）及撤管后0.5 h（T4）时心率（HR）、平均动脉压（MAP）、右心房压（RAP）、动脉血氧分压（PaO₂），计算氧合指数（PaO₂/FiO₂）、呼吸指数（RI），记录术后24 h临床肺部感染评分（CPIS）、PACU停留时间、术后住院时间，比较三组手术前及手术结束后血清肺表面活性蛋白A（SP-A）、Clara细胞分泌蛋白（CC16）表达水平及术后肺部并发症发生率。结果：三组在T0、T1、T2、T3和T4时HR、MAP、RAP比较无差异（P>0.05）；在T1、T2、T3和T4时，A组PaO₂、PaO₂/FiO₂均小于B组和C组，RI均大于B组和C组（P<0.05）；而B组与C组在各时间点PaO₂、PaO₂/FiO₂、RI比较无差异（P>0.05）；三组PACU停留时间比较无差异（P>0.05）；B组术后CPIS评分低于A组和C组，术后住院时间短于A组和C组（P<0.05）；C组术后血清SP-A、CC16表达水平均高于A组和B组（P<0.05）；B组术后肺部并发症发生率低于A组和C组（P<0.05）。结论：50%的吸入氧浓度联合PCV-VG模式可有效改善行腹腔镜膀胱癌根治术的老年患者的氧合功能，减轻肺损伤，对于减少术后并发症发生和促进康复具有积极作用，值得临床予以重视。

Effects of Different Inhalation Oxygen Concentrations Combined with PCV-VG Mode on Oxygenation and Lung Injury in Elderly Patients with Laparoscopic Bladder Cancer

ABSTRACT Objective: To investigate the effects of different inhalation oxygen concentrations combined with pressure-controlled volume-assured ventilation mode(PCV-VG) on oxygenation and lung injury in elderly patients with laparoscopic bladder cancer. Methods: 90 elderly patients with bladder cancer who planned to undergo laparoscopic radical surgery for bladder cancer under general anesthesia in our hospital from March 2022 to March 2023 were selected as research objects and randomly divided into group A, group B and group C, with 30 cases in each group. All patients maintained mechanical ventilation in PCV-VG mode, and the inhaled oxygen concentrations in groups A, B, and C were 40%, 50%, and 60%, respectively. Heart rate(HR), mean arterial pressure(MAP), right atrial pressure(RAP) and partial arterial oxygen pressure(PaO₂) were detected before ventilation(T0), 1 h, 2 h and 3 h after ventilation(T1-3) and 0.5 h after catheter removal(T4). Oxygenation index(PaO₂/FiO₂) and respiratory index(RI) were calculated. Clinical pulmonary infection score(CPIS),residence time of PACU and postoperative hospital stay were recorded 24 hours after surgery. The expression levels of serum pulmonary surface active protein A(SP-A) and Clara cell secreted protein(CC16) before and after surgery and the incidence of postoperative pulmonary complications were compared among the three groups. Results: There was no difference in HR, MAP and RAP among the three groups at T0, T1, T2, T3 and T4 (P>0.05). At T1, T2, T3 and T4, PaO₂ and PaO₂/FiO₂ in group A were lower than those in group B and C,and RI was higher than those in group B and C(P<0.05). There were no significant differences in PaO₂, PaO₂/FiO₂ and RI between group B and group C at each time point(P>0.05). There was no significant difference in PACU residence time among the three groups (P>0.05). The postoperative CPIS score of group B was lower than that of group A and C, and the postoperative hospitalization time was shorter than that of group A and C(P<0.05). The expression levels of SP-A and CC16 in group B were lower than those in group A and group C (P<0.05). The incidence of postoperative pulmonary complications in group B was lower than that in group A and group C (P<0. 05). Conclusion: 50% inhalation oxygen concentration combined with PCV-VG mode can effectively improve the oxygenation function and reduce lung injury in elderly patients with laparoscopic bladder cancer, and has a positive effect on reducing postoperative complications and promoting rehabilitation, which is worthy of clinical attention.