氧分压引导吸入氧浓度调整对老年患者胃癌 根治术术后肺不张的影响

The Effect of Arterial Oxygen Partial Pressure-Guided Titration of Inspired Oxygen Concentration on Postoperative Atelectasis in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer

摘要: 目的：研究氧分压引导吸入氧浓度调整对老年患者胃癌根治术术后肺不张的影响。方法：本研究为随机对照试验，选择在本院接受胃癌根治术的患者90例，随机分为两组，每组45例。两组插管前均使用吸入氧浓度100%面罩通气3 min，插管后行手法复张，调整呼吸参数，拔管后，患者在环境空气中被转移到AICU，AICU期间设置氧流量3 L/min鼻导管吸氧。不同的是A组在插管后通过调整FiO₂观察血气分析的PaO₂值使得110 ≤ PaO₂ ≤ 160。B组插管后使用80%吸入氧浓度维持。结果：主要结局：A组的肺超声评分明显低于B组(P < 0.05)，两组差异有统计学意义，A组的肺不张发生率与B组无统计学意义(P > 0.05)，A组的肺不张发生率明显低于B组(P < 0.05)，两组差异有统计学意义。次要结局：与T0时相比，术中各时间点(T1~T4)两组SpO₂均维持在较高且相似水平，组间比较差异无统计学意义(P > 0.05)。术后30 min (T5)时A组SpO₂显著低于B组，差异有统计学意义(P < 0.05)。与T0时相比，两组患者术中HR均呈下降趋势。组间比较显示，在T3时A组HR显著低于B组，差异有统计学意义(P < 0.05)。其余各时间点两组HR差异均无统计学意义(P > 0.05)。两组患者术中及术后MAP均显著降低。组间比较显示，术中及术后各时间点(T1~T5)两组MAP差异均无统计学意义(P > 0.05)。在术后手术切口感染发生率、住院时间、住院期间死亡率方面，两组间差异无统计学意义。结论：使用氧分压导向吸入氧浓度滴定相比固定高氧浓度可以减少术后肺不张的发生。

Abstract: Objective: To investigate the effect of different intraoperative inspired oxygen concentrations (FiO₂) on postoperative atelectasis in elderly patients undergoing radical gastrectomy for gastric cancer. Methods: This was a randomized controlled trial. Ninety patients who underwent radical gastrectomy for gastric cancer at our hospital were randomly divided into two groups of 45 each. Both groups received 100% oxygen via face mask for 3 minutes before intubation. Manual re-expansion was performed after intubation, and respiratory parameters were adjusted. After extubation, patients were transferred to the AICU in ambient air, where they received nasal cannula oxygen at a flow rate of 3 L/min. The difference was that in group A, after intubation, PaO₂ values in blood gas analysis were adjusted by monitoring FiO₂ to ensure 110 ≤ PaO₂ ≤ 160. In group B, 80% oxygen was maintained after intubation. Results: Primary outcomes: The lung ultrasound score of group A was significantly lower than that of group B (P < 0.05), and the difference between the two groups was statistically significant. The incidence of atelectasis in group A was not statistically significant compared with that in group B (P > 0.05), but the incidence of atelectasis in group A was significantly lower than that in group B (P < 0.05), and the difference between the two groups was statistically significant. Secondary outcomes: Compared to T0, SpO₂ remained at similar and high levels in both groups at all intraoperative time points (T1~T4), with no statistically significant difference between the groups (P > 0.05). At 30 min postoperatively (T5), SpO₂ in group A was significantly lower than that in group B (P < 0.05). Compared to T0, intraoperative heart rate (HR) decreased in both groups. Intergroup comparison showed that at T3, HR in group A was significantly lower than that in group B (P < 0.05). There were no statistically significant differences in HR between the two groups at any other time point (P > 0.05). MAP decreased significantly in both groups both intraoperatively and postoperatively. Intergroup comparison showed no statistically significant differences in MAP between the two groups at any intraoperative and postoperative time points (T1~T5) (P > 0.05). There were no statistically significant differences between the two groups in postoperative surgical site infection rate, length of hospital stay, and in-hospital mortality. Conclusion: Oxygen partial pressure-guided titration of inspired oxygen concentration, compared to a fixed high FiO₂ strategy, can reduce the incidence of postoperative atelectasis in elderly patients undergoing radical gastrectomy.