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