摘要
目的 评价经皮穴位电刺激(TEAS)联合呼吸训练对腹腔镜手术老年患者术后肺部并发症(PPCs)的影响。方法 选择择期全麻下行腹腔镜胃肠道肿瘤根治术患者111例,男71例,女40例,年龄65~75岁,BMI 20~30 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为三组:对照组(A组,n=36)、术前呼吸训练组(B组,n=38)和TEAS联合术前呼吸训练组(C组,n=37)。A组接受常规围术期护理;B组在常规围术期护理的基础上进行术前呼吸训练;C组在B组的基础上进行TEAS。于术前1 d和术后1 d测定血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)浓度。记录术后7 d内PPCs的发生情况,包括低氧血症、肺部感染、肺不张、胸腔积液。记录拔管时间、PACU停留时间、术后住院时间。结果 与术前1 d比较,术后1 d三组血清IL-1β和TNF-α浓度明显升高(P<0.05)。与A组比较,术后1 d C组血清IL-1β和TNF-α浓度明显降低(P<0.05)。术后1 d A组和B组血清IL-1β和TNF-α浓度差异无统计学意义。与A组比较,B组和C组术后7 d内PPCs总发生率明显降低,PACU停留时间、术后住院时间明显缩短(P<0.05)。与B组比较,C组术后7 d内PPCs总发生率明显降低,术后住院时间明显缩短(P<0.05)。结论 TEAS联合术前呼吸训练可减轻腹腔镜手术老年患者术后炎症反应,降低患者PPCs总发生率,缩短患者术后住院时间。
Objective To evaluate the effect of transcutaneous electrical acupoint stimulation(TEAS)combined with respiratory training on postoperative pulmonary complications(PPCs)in elderly patients undergoing laparoscopic surgery.Methods A total of 111 patients undergoing laparoscopic radical resection of gastrointestinal tumors under elective general anesthesia,71 males and 40 females,aged 65-75 years,BMI 20-30 kg/m^(2),ASA physical atatusⅡorⅢ,were selected.The patients were divided into three groups by random number table method:control group(group A,n=36),preoperative respiratory training group(group B,n=38),and TEAS combined with preoperative respiratory training group(group C,n=37).Group A received conventional perioperative care,group B underwent preoperative respiratory training based on conventional perioperative care,and group C underwent TEAS on the basis of group B.The serum interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)were measured 1 day before and 1 day after surgery.The occurrence of PPCs within 7 days after surgery were recorded,including hypoxemia,pulmonary infection,atelectasis,and pleural effusion.Extubation time,PACU retention time,and postoperative hospitalization time were recorded.Results Compared with the preoperative 1 day,serum IL-1βand TNF-αconcentrations were significantly higher at 1 day postoperatively in all the three groups(P<0.05).Serum IL-1βand TNF-αconcentrations were significantly lower at 1 day postoperatively in group C compared with group A(P<0.05).There was no significant difference in serum IL-1βand TNF-αbetween group A and group B 1 day after operation.Compared with group A,the total incidence of PPCs within 7 days postoperatively was reduced in groups B and C,and the PACU retention time and postoperative hospitalization time were significantly shorter(P<0.05).Compared with group B,the total incidence of PPCs in group C within 7 days after surgery was significantly reduced,and the postoperative hospitalization time was significantly shorter(P<0.05).Conclusion TEAS combined with preoperative respiratory training attenuates postoperative inflammatory responses,reduces the total incidence of PPCs,and shortens postoperative hospitalization time in elderly patients undergoing laparoscopic surgery.
作者
罗超
涂育铭
高巨
林舜艳
郭松青
李勇
LUO Chao;TU Yuming;GAO Ju;LIN Shunyan;GUO Songqing;LI Yong(Department of Anesthesiology,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Northern Jiangsu People's Hospital,Yangzhou 225001,China)
出处
《临床麻醉学杂志》
北大核心
2025年第2期151-154,共4页
Journal of Clinical Anesthesiology
关键词
经皮穴位电刺激
呼吸训练
老年
术后肺部并发症
Transcutaneous electrical acupoint stimulation
Respiratory training
Aged
Postoperative pulmonary complications
