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    硬膜外复合全身麻醉对肿瘤细胞减灭术联合腹腔热灌注化疗病人围术期肺功能影响的临床研究

    Clinical study of the effects of epidural combined with general anesthesia on the perioperative pulmonary function in patients treated with cytoreductive surgery combineds with hyperthermic intraperitoneal chemotherapy

      摘要
    • 摘要:
      目的： 探讨硬膜外复合全身麻醉对肿瘤细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）病人围术期肺功能的影响。
      方法： 选取2018年1月至2019年3月于北京世纪坛医院行CRS联合HIPEC病人120例，按随机数字表法分为观察组（硬膜外复合全凭静脉麻醉）和对照组（全凭静脉麻醉），各60例。分别于气管插管后5 min（T0）、手术开始后1 h（T1）、HIPEC开始前（T2）、HIPEC结束时（T3）、手术结束时（T4），记录机械通气时的气道峰压（Ppeak）、气道平台压（Pplat）、平均气道压（Pmean），计算动态肺顺应性（Cdyn）；于各时点取桡动脉血行血气分析，记录动脉血氧分压（PaO2），计算氧合指数（OI）、呼吸指数（RI）、肺泡–动脉血氧分压差（A–aDO2）及死腔率（VD/VT）。记录术后7 d内肺部并发症发生情况。
      结果： 观察组在T3、T4时点的PaO2、Cdyn均高于对照组，Ppeak、Pplat、Pmean低于对照组均（P ＜ 0.01）；T3、T4时点的OI、RI、A–aDO2均优于对照组（P ＜ 0.05 ~ P ＜ 0.01），各时间点VD/VT组间差异均无统计学意义（P ＞ 0.05）。观察组术后7 d内肺部并发症总发生率为15.00%，低于对照组的35.00%（P ＜ 0.05）。
      结论： 硬膜外复合全身麻醉可改善CRS联合HIPEC病人围术期呼吸力学及肺功能，降低肺部并发症发生率。

       

      Abstract:
      Objective To investigate the effects of epidural combined with general anesthesia on the perioperative pulmonary function in patients treated with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).
      Methods A total of 120 patients who underwent CRS combined with HIPEC in Beijing Shijitan Hospital from January 2018 to March 2019 were selected, and divided into the observation group (epidural combined with total intravenous anesthesia) and control group (total intravenous anesthesia) according to the random number table method, with 60 cases in each group. The peak airway pressure (Ppeak), plateau airway pressure (Pplat) and mean airway pressure (Pmean) during mechanical ventilation were recorded at 5 minutes after tracheal intubation (T0), 1 hour after the start of surgery (T1), before the start of HIPEC (T2), at the end of HIPEC (T3) and at the end of the surgery (T4). The dynamic lung compliance (Cdyn) was calculated. Radial artery blood was collected at each time point for blood gas analysis. The arterial partial pressure of oxygen (PaO2) was recorded, and the oxygenation index (OI), respiratory index (RI), alveolar-arterial partial pressure difference of oxygen (A-aDO2) and dead cavity rate (VD/VT) were calculated. The occurrence of pulmonary complications within 7 days after the operation were recorded.
      Results The PaO2 and Cdyn at T3 and T4 in the observation group were higher than those in the control group, while the Ppeak, Pplat and Pmean were lower than those in the control group (P ＜ 0.01). The OI, RI and A-aDO2 at T3 and T4 in the observation group were all better than those in the control group (P ＜ 0.05 to P ＜ 0.01), and there was no statistical significance in the VD/VT between two groups at each time point (P ＞ 0.05). The total incidence of pulmonary complications within 7 days after surgery in the observation group was 15.00%, which was lower than 35.00% in the control group (P ＜ 0.05).
      Conclusions Epidural combined with general anesthesia can improve perioperative respiratory mechanics and pulmonary function in patients with CRS combined with HIPEC, and reduce the incidence of pulmonary complications

       

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