| 摘要: |
| 目的 探讨术后长时程吸氧对肝癌伴肝肺综合征患者全麻下行肝切除术后全身炎症反应、肺内分流及预后的影响。方法 选取2017年1月至2018年12月在陆军军医大学（第三军医大学）西南医院麻醉科行择期肝切除术的肝癌伴肝肺综合征患者72例，美国麻醉医师协会（ASA）分级为Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：对照组（n=36），术毕回病房经鼻导管低流量（2～3 L/min）吸氧8 h；试验组（n=36），经鼻导管低流量（2～3 L/min）吸氧48 h。于麻醉前、术毕、术后8 h、术后24 h、术后48 h、术后72 h分别经桡动脉抽取动脉血进行血气分析，观察动脉血氧分压（PaO2）、肺泡气-动脉血氧分压差[（A-a）DO2]的变化，同时测定并分析两组患者外周血肿瘤坏死因子α（TNF-α）、外周血脂多糖（LPS）、呼出气一氧化氮含量（FeNO）的变化；于术后48 h检测外周血C-反应蛋白（CRP）、白细胞计数、中性粒细胞比例；记录两组患者术后肺部并发症发生率和住院时间并进行比较。结果 两组患者在术毕和术后8 h时点PaO2均高于麻醉前，（A-a）DO2均低于麻醉前（P均<0.05）；试验组在术后24 h和48 h时点PaO2均高于麻醉前，（A-a）DO2均低于麻醉前（P均<0.05）；对照组在术后24 h和48 h时点PaO2均低于麻醉前，（A-a）DO2均高于麻醉前（P均<0.05）；术后24 h和48 h时点，试验组PaO2均高于对照组，（A-a）DO2均低于对照组（P均<0.05）。试验组在术后8 h、24 h、48 h时点外周血LPS、外周血TNF-α和FeNO均低于麻醉前（P均<0.05），对照组在术后24 h、48 h时点外周血LPS、外周血TNF-α和FeNO均高于麻醉前（P均<0.05）；术后24 h和48 h时点，试验组外周血LPS、外周血TNF-α和FeNO均低于对照组（P均<0.05）。术后48 h时点，试验组炎症反应指标CRP、白细胞计数、中性粒细胞比例均低于对照组（P均<0.05）。试验组术后肺部并发症发生率（1/36）低于对照组（6/36），住院时间[（5.2±2.3）d]短于对照组[（7.8±3.2）d]，差异均有统计学意义（P均<0.05）。结论 术后延长吸氧时限至48 h能有效减轻肝肺综合征患者肝癌切除术后全身炎症反应，减少肺内分流，降低肺部并发症的发生率，利于患者术后恢复。 |
| 关键词: 肝肺综合征 肝切除术 长时程吸氧 肺部并发症 |
| DOI：10.16781/j.0258-879x.2019.10.1083 |
| 投稿时间：2019-08-12修订日期：2019-09-18 |
| 基金项目:国家自然科学基金面上项目（81870422，81670552）. |
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| Effect of prolonged low-flow nasal cannula oxygen inhalation time on recovery after hepatectomy in hepatocarcinoma patients with hepatopulmonary syndrome |
| HAN Yi,LI Yu-jie,CHEN Lin,BAI Xue-hong,LU Kai-zhi,YI Bin* |
(Department of Battle Field Surgery Anesthesia, Southwest Hospital, Army Medical University(Third Military Medical University), Chongqing 400038, China
*Corresponding author) |
| Abstract: |
| Objective To explore the effect of prolonged low-flow oxygen inhalation time through nasal cannula on systemic inflammatory response, intrapulmonary shunt and prognosis after hepatectomy under general anesthesia in hepatocarcinoma patients with hepatopulmonary syndrome. Methods Seventy-two patients of hepatocarcinoma with hepatopulmonary syndrome, who underwent hepatectomy in Anesthesia Department of Southwest Hospital of Army Medical University (Third Military Medical University) from Jan. 2017 to Dec. 2018, were enrolled in this study. Their American Society of Anesthesiologists (ASA) grades were classified as grade Ⅱ or Ⅲ. All patients were randomized into control group (n=36) and research group (n=36). The patients in the control group inhaled low-flow oxygen (2-3 L/min) through nasal cannula for 8 h after operation, and those in the research group for 48 h. Before anesthesia, and immediately, 8 h, 24 h, 48 h and 72 h after operation, the radial artery blood gas analysis was conducted to record arterial partial pressure of oxygen (PaO2) and alveolar-arterial oxygen pressure difference ([A-a]DO2). At each time point, tumor necrosis factor α (TNF-α) and lipopolysaccharide (LPS) in peripheral blood and fractional exhaled nitric oxide (FeNO) were measured as well. C-reactive protein (CRP), white blood cell count and neutrophil proportion in peripheral blood were measured 48 h after operation. The incidence of postoperative pulmonary complications and hospital stay were compared between the two groups. Results In the two groups, the PaO2 values were significantly higher immediately and 8 h after operation versus before anesthesia, and the (A-a)DO2 values were significantly lower (all P<0.05). At 24 h and 48 h after operation, the PaO2 values in the research group were significantly higher than that before anesthesia, and the (A-a)DO2 values were significantly lower than that before anesthesia (all P<0.05); while those in the control group showed the opposites (all P<0.05); and the PaO2 values in the research group were significantly higher than those in the control group, and (A-a)DO2 values were significantly lower (all P<0.05). The levels of LPS, TNF-α and FeNO in the research group 8, 24 and 48 h after operation were significantly lower than those before anesthesia (all P<0.05), while those in the control group 24 and 48 h after operation were significantly higher than those before anesthesia (all P<0.05). The levels of LPS, TNF-α and FeNO in the research group were significantly lower than those in the control group 24 and 48 h after operation (all P<0.05). At 48 h after operation, CRP level, white blood cell count and neutrophil proportion in the research group were significantly lower than those in the control group (all P<0.05). The incidence of postoperative pulmonary complications in the research group (1/36) was lower than that in the control group (6/36), and the hospital stay ([5.2±2.3] d) was shorter than that in the control group ([7.8±3.2] d), and the differences were statistically significant (both P<0.05). Conclusion Prolonged oxygen inhalation time (48 h) can effectively alleviate systemic inflammatory response, reduce intrapulmonary shunt and the incidence of pulmonary complications, thus facilitating postoperative recovery after hepatectomy in patients of hepatocarcinoma with hepatopulmonary syndrome. |
| Key words: hepatopulmonary syndrome hepatectomy prolonged oxygen inhalation pulmonary complications |
