不同吸入氧浓度对腹腔镜膀胱癌根治术 老年患者氧合功能及术后肺部 并发症的影响

Effects of Different Fractions of Inspired Oxygen on Oxygenation Function and Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopic Radical Cystectomy

摘要: 目的：研究不同吸入氧浓度对腹腔镜膀胱癌根治术老年患者氧合功能及术后肺部并发症的影响。方法：选取接受腹腔镜膀胱癌根治术的患者60例，年龄 ≥ 65岁，体重指数(body mass index, BMI) 18~28 kg/m²，ASA I~III级，术前心肺功能未见明显异常，无困难气道、哮喘或慢性阻塞性肺疾病等；预计气腹时间2~4 h；肝肾功能未见明显异常。随机分为两组：A组(FiO₂ = 50%)、B组(FiO₂ = 80%)，每组各30例。两组患者均采用全身麻醉，术中维持对应吸入氧浓度(Fraction of inspired oxygen, FiO₂)至手术结束，术后清醒拔管后转入术后恢复室(Post-anesthesia care unit, PACU)观察，之后转入普通病房常规护理。术中在头低脚高位时保持组间手术床倾斜角度基本相同。分别于麻醉诱导前(T₀)、气管插管后5 min时(T₁)、Trendelenburg体位后60 min时(T₂)、Trendelenburg体位后120 min时(T₃)、拔管后30 min (T₄)五个时间点采集动脉血进行血气分析记录动脉血氧分压(PaO₂)和动脉血二氧化碳分压(PaCO₂)，计算氧合指数(OI)。观察记录术后第1、2、7天的短期术后肺部并发症的发生情况。结果：两组患者各时间点的PaCO₂均在正常范围，组间比较差异均无统计学意义(P > 0.05)。T₀时，两组患者PaO₂、OI比较，差异无统计学意义(P > 0.05)。在T₁~T₃时，B组患者PaO₂明显高于A组患者，差异有统计学意义(P < 0.05)，A组患者OI明显高于B组患者，差异有统计学意义(P < 0.05)。无统计学差异(P > 0.05)，T₄时两组PaO₂均明显降低，差异无统计学意义(P > 0.05)。两组的术后肺部并发症发生率差异无统计学意义(P > 0.05)。结论：腹腔镜膀胱癌根治术老年患者术中采用50%吸入氧浓度(A组)的氧合指数显著优于80%吸入氧浓度(B组)，且两组术后肺部并发症发生率无统计学差异，提示术中采用50%吸入氧浓度更有利于改善老年患者围术期氧合功能，且不会增加术后肺部并发症风险，可作为此类患者术中首选的吸入氧浓度方案。

Abstract: Objective: To investigate the effects of different fractions of inspired oxygen on oxygenation function and postoperative pulmonary complications in elderly patients undergoing laparoscopic radical cystectomy. Methods: Sixty patients aged ≥65 years undergoing laparoscopic radical cystectomy were enrolled. Inclusion criteria were body mass index (BMI) 18~28 kg/m², ASA physical status I~III, no significant preoperative cardiopulmonary abnormalities, absence of difficult airway, asthma, or chronic obstructive pulmonary disease (COPD), estimated pneumoperitoneum duration of 2~4 hours, and no significant hepatic or renal dysfunction. Patients were randomly assigned to two groups: Group A (FiO₂ = 50%) and Group B (FiO₂ = 80%), with 30 patients per group. Both groups underwent general anesthesia. The corresponding inhaled oxygen concentration was maintained throughout surgery until completion. Postoperatively, patients were transferred to the recovery room after extubation and regained consciousness, then moved to the general ward for routine care. During surgery, the operating table tilt angle was maintained at a similar level between groups while positioning patients in the head-down, feet-up Trendelenburg position. Arterial blood samples were collected at five time points: before anesthesia induction (T₀), 5 minutes after tracheal intubation (T₁), 60 minutes after Trendelenburg positioning (T₂), 120 minutes after Trendelenburg positioning (T₃), and 30 minutes after extubation (T₄). Arterial blood samples were collected for blood gas analysis at these five time points to record arterial oxygen partial pressure (PaO₂), arterial carbon dioxide partial pressure (PaCO₂), and pH, and to calculate the oxygenation index (OI). Observe and record the incidence of pulmonary complications on postoperative days 1, 2, and 7. Results: PaCO₂ levels remained within normal ranges at all time points for both patient groups, with no statistically significant differences between groups (P > 0.05). At T₀, comparisons of PaO₂ and OI between groups showed no statistically significant differences (P > 0.05). From T₁ to T₃, Group B patients exhibited significantly higher PaO₂ than Group A patients (P < 0.05), while Group A patients had significantly higher OI than Group B patients (P < 0.05). No statistically significant difference was observed (P > 0.05). At T₄, PaO₂ decreased significantly in both groups, with no statistically significant difference between them (P > 0.05). The incidence of postoperative pulmonary complications differed non-significantly between groups (P > 0.05). Conclusion: In elderly patients undergoing laparoscopic radical cystectomy, intraoperative oxygenation index was significantly superior in the group receiving 50% fraction of inspired oxygen (Group A) compared to the group receiving 80% fraction of inspired oxygen (Group B). Furthermore, there was no statistically significant difference in the incidence of postoperative pulmonary complications between the two groups, suggesting that 50% fraction of inspired oxygen is more beneficial for improving perioperative oxygenation in elderly patients without increasing the risk of postoperative pulmonary complications. It may serve as the preferred fraction of inspired oxygen regimen for this patient population.