实用老年医学

实用老年医学 ›› 2026, Vol. 40 ›› Issue (1): 48-52.doi: 10.3969/j.issn.1003-9198.2026.01.010

• 临床研究 • 上一篇    下一篇

轻度过度通气对老年腹腔镜结直肠癌根治术患者短期膈肌功能的影响

何林丹, 丰嘉露, 陈昱瑄, 张邓新   

  1. 221000 江苏省徐州市,徐州医科大学江苏省麻醉学重点实验室(何林丹,丰嘉露,张邓新);
    214000 江苏省无锡市,江南大学无锡医学院(陈昱瑄)
  • 收稿日期:2025-05-09 发布日期:2026-01-16
  • 通讯作者: 张邓新,Email:9812015228@jiangnan.edu.cn
  • 基金资助:
    江苏省老年健康科研项目(LKZ2023015);无锡市卫健委重大科研项目(Z202211)

Effects of mild hyperventilation on short-term diaphragmatic function in elderly patients undergoing laparoscopic radical resection of colorectal cancer

HE Lindan, FENG Jialu, CHEN Yuxuan, ZHANG Dengxin   

  1. Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221000, China (HE Lindan, FENG Jialu,ZHANG Dengxin);
    Wuxi Medical College, Jiangnan University,Wuxi 214000,China (CHEN Yuxuan)
  • Received:2025-05-09 Published:2026-01-16
  • Contact: ZHANG Dengxin, Email:9812015228@jiangnan.edu.cn

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摘要： 目的 探究轻度过度通气对接受腹腔镜结直肠癌根治术的老年患者术后短期膈肌功能及认知功能的影响。 方法 纳入择期全麻下行腹腔镜结直肠癌根治术的老年患者88例,采用随机数表法将患者分为控制性过度通气组(H组)和常规通气组(C组),每组44例。2组在麻醉诱导气管插管后均使用容量控制呼吸模式机械通气,通过调整呼吸频率(RR)使C组维持呼气末二氧化碳分压(PetCO2)为35~45 mmHg,H组维持PetCO2为30～34 mmHg。检测麻醉前(T0)、CO2气腹建立后即刻(T1)、CO2气腹建立后1 h(T2)、CO2气腹建立后2 h(T3)、拔管后即刻(T4)的动脉血气;记录2组术前12 h及术后6、24、48 h的MMSE评分。应用M型超声测量2组T0和T4时刻的膈肌移动度(DE)及膈肌浅快呼吸指数(D-RSBI)。 结果 与H组比较,C组患者术后DE下降更明显,D-RSBI上升更明显(P<0.05)。与C组相比,H组T2、T3、T4时的pH值更高、PaCO2更低(P<0.05);H组术后膈肌功能障碍的发生率较C组显著降低(P<0.05)。2组其他指标比较,差异无统计学意义。 结论 控制PetCO2在30~34 mmHg的轻度过度通气,可改善行腹腔镜下结直肠癌根治术的老年患者术后短期的膈肌功能,且未造成患者术后认知功能的不良影响。

关键词: 膈肌超声, 膈肌功能, 控制性过度通气, 肺保护

Abstract: Objective To investigate the effects of mild hyperventilation on short-term postoperative diaphragmatic function in elderly patients undergoing laparoscopic radical resection for colorectal cancer, and to analyze the effects on postoperative cognitive function. Methods Eighty-eight elderly patients scheduled for elective laparoscopic colorectal surgery under general anesthesia were enrolled. They were randomly divided into the controlled hyperventilation group (Group H) and the conventional ventilation group (Group C) according to random number table, with 44 cases in each group. After induction of anesthesia and endotracheal intubation, both groups received mechanical ventilation in volume-controlled ventilation (VCV) mode. The respiratory rate (RR) was adjusted to maintain an end-tidal carbon dioxide partial pressure (PetCO2) of 35-45 mmHg in Group C and 30-34 mmHg in Group H. Arterial blood gas analysis was performed at the following time points: before anesthesia (T0), immediately after CO2 pneumoperitoneum establishment (T1), 1 h after pneumoperitoneum (T2), 2 h after pneumoperitoneum (T3), and immediately after extubation (T4). The score of the Mini-Mental State Examination (MMSE) was recorded 12 h before operation and 6, 24, and 48 h after operation. M-mode ultrasonography was used to measure diaphragmatic excursion (DE) and the diaphragmatic rapid shallow breathing index (D-RSBI) at T0 and T4. Results Compared to Group H, Group C showed a more significant decrease in postoperative diaphragmatic excursion and a more significant increase in the level of D-RSBI (P<0.05). At T2, T3 and T4, Group H had significantly higher pH values (P<0.05) and lower PaCO2 levels (P<0.05) compared to Group C. The incidence rate of postoperative diaphragmatic dysfunction showed significant difference between the two groups (P< 0.05). There were no statistically significant differences in the other indexes between the two groups. Conclusions Maintaining mild hyperventilation with a target PetCO2 of 30-34 mmHg can improve short-term postoperative diaphragmatic function in elderly patients undergoing laparoscopic radical resection for colorectal cancer, without exerting adverse effects on postoperative cognitive function.

Key words: diaphragmatic ultrasound, diaphragmatic function, controlled hyperventilation, lung protection

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