实用医学杂志 ›› 2022, Vol. 38 ›› Issue (10): 1246-1250.doi: 10.3969/j.issn.1006⁃5725.2022.10.014

• 临床研究 • 上一篇    下一篇

腹腔镜下食管裂孔疝并发胃食管返流患者肺通气功能行保护性康复的疗效

张锋 焦亚星 徐广剑    

  1. 东南大学医学院附属徐州医院(徐州市中心医院)呼吸与危重症医学区(江苏徐州 221009)

  • 出版日期:2022-05-25 发布日期:2022-05-25
  • 通讯作者: 徐广剑 E⁃mail:caozhengqing1109@163.com
  • 基金资助:
    江苏省青年医学重点人才培养计划(编号:QNRC2016382)

Evaluation of protective rehabilitation intervention for pulmonary ventilation function in patients undergo⁃ ing laparoscopic hiatal hernia repair complicated with GRED

ZHANG Feng,JIAO Yaxing,XU Guangjian.   

  1. Department of Respiratory and Critical Care MedicineXuzhou Hospital Affiliated to Medical CollegeSoutheast Uni⁃ versityXuzhou Central HospitalXuzhou 221009China 
  • Online:2022-05-25 Published:2022-05-25
  • Contact: XU Guangjian E⁃mail:caozhengqing1109@163.com

摘要:

目的 评估腹腔镜下食管裂孔疝并发胃食管返流(GRED)患者针对其肺通气功能行保护性康复干预的临床效果。方法 选取我院 2017 8 月至 2019 3 月收治的 68 例腹腔镜下食管裂孔疝合并 GRED 患者作为研究对象。随机分为两组,保护组 34 例,实施保护性康复干预,容量组 34 例,实施传统容 量控制性康复干预。观察并记录两组患者气腹前(t0)、气腹后 2 h(t1)、4 h(t2)、术后 24 h(t3)的平均动脉压 MAP)、中心静脉压(CVP)、肺顺应性(C)、肺泡⁃动脉血氧分压差(A⁃aDO2)、呼气末二氧化碳分压(PETCO2)、 氧合指数(OI)、心率(HR)和呼吸频率(RR)及相关并发症发生情况,并结合术后住院天数综合评价患者术后 康复效果。结果 与t0相比,患者术后MAP和CVP均明显升高,C明显降低(P < 0.05);t1、t2时刻保护组C的降 幅大于容量组(P < 0.05)。与t0相比,患者A⁃aDO2和PETCO2均明显降低(P < 0.05);t1、t2、t3时刻保护组A⁃aDO2 和PETCO2降幅大于容量组(P < 0.05)。与t0相比,患者OI和RR均明显升高,保护组HR在t1、t2时刻明显降低 P < 0.05),容量组HR各时段变化值与t0时刻相比差异无统计学意义(P > 0.05);t1、t2、t3时刻保护组OI、RR 幅大于容量组(P < 0.05)。保护组相关并发症累计发生率、住院天数均低于容量组(P < 0.05)。结论 保护性康复干预更有利于腹腔镜下食管裂孔疝合并GRED患者的肺通气功能恢复,值得推广。

关键词:

食管裂孔疝, 胃食管返流, 肺保护性通气策略, 肺通气功能, 康复干预

Abstract:

Objective To evaluate the clinical effect of protective rehabilitation intervention for pulmonary ventilation function in patients undergoing laparoscopic hiatal hernia repair complicated with GRED. Methods Sixty⁃ eight patients undergoing laparoscopic hiatal hernia repair(LHHR)complicated with GRED who were admitted to our hospital from August 2017 to March 2019 were selected as the research object. They were randomly divided into protection group and volume group,with 34 in each group. The mean arterial pressure(MAP),central venous pressure(CVP),pulmonary compliance(C),alveolar⁃arterial differential blood oxygen pressure(A⁃ADO2), end ⁃expiratory partial pressure of carbon dioxide(PETCO2),oxygenation index(OI),and pulmonary compliance (C)were observed and recorded before pneumoperitoneum(T0),2 h(T1),4 h(T2)and 24 h(T3)after pneumo⁃ peritoneum in the 2 groups. The incidence of heart rate(HR),respiratory rate(RR)and related complications combined with the length of postoperative hospital stay,were evaluated for the postoperative rehabilitation effect. Results Compared with those before pneumoperitoneum(T0),postoperative MAP and CVP were significantly increased,while C was significantly decreased(P < 0.05). At T1 and T2,the decrease of C in protection group was greater than that in volumn group(P < 0.05). Compared with those before pneumoperitoneum,a⁃ADO2 and PETCO2 were significantly decreased in patients(P < 0.05). At T1,T2 and T3,the decrease of A⁃ADO2 and PETCO2 in the protection group was greater than that in the capacity group(P < 0.05). Compared with those before pneumoperito⁃ neum,OI and RR were significantly increased,and HR in the protection group was significantly decreased at T1 and T2(P < 0.05),while the change of HR in the volume group at T1,T2 and T3 was insignificant when compared with that before pneumoperitoneum(P > 0.05). At T1,T2 and T3,OI and RR of the protection group increased more than those of the volume group(P < 0.05). There were lower cumulative incidence of related complications andless hospitalization days in the protection group(P < 0.05). Conclusion Protective rehabilitation intervention is conducive to the recovery of pulmonary ventilation in patients undergoing LHHR complicated with GRED,which is worthy of promotion.

Key words:

hiatal hernia of esophagus, gastroesophageal reflux, lungprotectiveventilationstrategy, pulmonary ventilation function, rehabilitation intervention