肺保护性通气在老年病人腹腔镜肾癌根治术中的应用

doi:10.3969/j.issn.1003-9198.2023.09.010

Abstract

Abstract: Objective To investigate the effect of lung protective ventilation in laparoscopic radical nephrectomy in the elderly patients. Methods A total of 106 patients with primary renal cancer who received laparoscopic radical nephrectomy in our hospital from October 2020 to October 2021 were enrolled and randomly divided into the control group and the lung protective ventilation group, with 53 cases in each group. The control group received general anesthesia and routine intraoperative ventilation, while the lung protective ventilation group received general anesthesia and intraoperative lung protective ventilation. Lung compliance[peak pressure (Ppeak), airway plateau pressure (Pplat), oxygenation index (PaO₂/FiO₂), lung dynamic compliance (Cdyn)], serum inflammation and oxidative stress [interleukin-6(IL-6), interleukin-8(IL-8), tumor necrosis factor α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD)], hemodynamic indicators [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)] and the incidence of complications between the two groups were compared. Results The levels of Ppeak, Pplat, IL-6, IL-8, TNF-α, MDA, SBP, DBP and HR in lung protective ventilation group were lower than those in control group, while the levels of SOD, PaO₂/FiO₂ and Cdyn levels were higher than those in control group(all P＜0.05) 2 h after pneumoperitoneum and after surgery. The total incidence rate of the complications in lung protective ventilation group was lower than that in control group(P＜0.05). Conclusions The application of lung protective ventilation in laparoscopic radical nephrectomy in elderly patients can improve intraoperative lung compliance, reduce inflammatory stress response, improve hemodynamics and reduce postoperative complications.

Key words: radical nephrectomy, laparoscope, lung protective ventilation, aged, lung dynamic compliance, complications

CLC Number:

R 737.11

ZHU Shan, DING Jia-hui, ZHANG Yan-mei, XU Hai-fei, ZHANG Hui, CAO Han-zhong. Application of lung protective ventilation in laparoscopic radical nephrectomy in elderly patients[J]. Practical Geriatrics, 2023, 37(9): 902-906.

References

[1] DE ALWIS R, HANSSON J, LINDGREN D, et al.Size-based isolation and detection of renal carcinoma cells from whole blood[J]. Mol Clin Oncol, 2022, 16(5): 101.
[2] HEYLIGER S O, SOLIMAN K F A, SAULSBURY M D, et al.Prognostic relevance of ZNF844 and Chr 19p13.2 KRAB-Zinc finger proteins in clear cell renal carcinoma[J]. Cancer Genomics Proteomics, 2022, 19(3): 305-327.
[3] SUO X, WANG Z, ZHU Y. Application effect of sevoflurane combined with remifentanil intravenous inhalation anesthesia in patients undergoing laparoscopic radical resection of cervical cancer[J]. Am J Transl Res, 2022, 14(2): 1034-1042.
[4] WANG Y, CAO M, CAO G, et al. Effect of combined intravenous-inhalation anesthesia on postoperative cognitive dysfunction after laparoscopic radical resection of cervical cancer: a protocol for systematic review and meta-analysis[J]. Medicine: Baltimore, 2020, 99(45): e23124.
[5] MA L, LI Q, GUO Y, et al.Laparoscopic nerve-sparing radical hysterectomy for the treatment of cervical cancer: a meta-analysis of randomized controlled trials[J]. World J Surg Oncol, 2021, 19(1): 301.
[6] 刘静,孟志鹏,颜伟,等. 肺保护性通气策略对腹腔镜胃癌根治手术老年患者肺氧合功能及术后肺部并发症的影响[J]. 临床麻醉学杂志,2019,35(4):344-347.
[7] 陈莹,曲宗阳,包杰,等.老年患者脊柱手术中肺保护性通气策略对呼吸参数的影响[J].临床麻醉学杂志,2021,37(7):724-727.
[8] 沈珀,沈亚南,张晨,等.肺超声评分评价肺保护性通气策略对老年开腹手术患者肺损伤的影响[J].临床麻醉学杂志,2021,37(9):901-905.
[9] MOHAMEDAHMED A Y Y, ZAMAN S, ALBENDARY M, et al. Laparoscopic versus open hepatectomy for malignant liver tumours in the elderly: systematic review and meta-analysis[J]. Updates Surg, 2021, 73(5): 1623-1641.
[10] CONTICCHIO M, DELVECCHIO A, RATTI F, et al. Laparoscopic surgery versus radiofrequency ablation for the treatment of single hepatocellular carcinoma ≤3 cm in the elderly: a propensity score matching analysis[J]. HPB: Oxford, 2022, 24(1): 79-86.
[11] 刘红,于立强,张茂银,等.PCV-VG通气模式对腹腔镜直肠癌根治患者肺保护的影响[J]. 医学研究杂志,2019,48(12):86-90.
[12] 黄新华,姚华琪,张洁. 不同通气模式对老年妇科腹腔镜手术患者的肺保护作用比较[J]. 全科医学临床与教育,2019,17(4):311-314.
[13] ABDEL-GHAFFAR H S, YOUSEFF H A, ABDELAL F A, et al. Post-extubation continuous positive airway pressure improves oxygenation after pediatric laparoscopic surgery: a randomized controlled trial[J]. Acta Anaesthesiol Scand, 2019, 63(5): 620-629.
[14] GARG J, KALE S, SABHARWAL N, et al. Hemodynamic, airway pressure, and capnometric changes and perioperative outcome in pediatric laparoscopic inguinal herniorrhaphy: a comparison with open inguinal herniorrhaphy[J]. Anesth Essays Res, 2018, 12(1): 165-169.
[15] LIU J, HUANG X, HU S, et al. Individualized lung protective ventilation vs. conventional ventilation during general anesthesia in laparoscopic total hysterectomy[J]. Exp Ther Med, 2020, 19(4): 3051-3059.
[16] JUN J H, CHUNG R K, BAIK H J, et al. The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation[J]. BMC Anesthesiol, 2019, 19(1): 142.
[17] 罗楠,刘明娣,刘泳. 补肾活血汤对术后认知功能障碍模型大鼠CREB/BDNF通路相关蛋白及炎症因子的影响[J]. 湖北中医药大学学报,2022,24(1): 22-26.
[18] 叶姣. 丙泊酚与七氟醚剂量配伍对合并轻度认知功能障碍的老年股骨颈骨折患者围术期氧化应激反应及术后认知功能的影响[J]. 陕西医学杂志,2019,48(10): 1298-1301.
[19] YOSHIMATSU K, KONO T, ITO Y, et al. Laparoscopic surgery reduces risk of postoperative complications and non cancer-related survival in patients over 80 years old with colorectal cancer[J]. Cancer Diagn Progn, 2021, 1(4): 297-301.

Application of lung protective ventilation in laparoscopic radical nephrectomy in elderly patients

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