肺复张策略用于腹腔镜胃癌根治术患者的临床研究

肺复张策略用于腹腔镜胃癌根治术患者的临床研究摘要：

目的：探讨肺复张策略在腹腔镜胃癌根治术中的临床应用价值。

方法：选取2018年1月至2021年12月在我院行腹腔镜胃癌根治术的患者，自愿加入肺复张策略组（60例）和肺未复张策略组（60例）。两组患者的术前生理指标、手术时间、术后并发症、住院时间和生命质量指数等方面进行比较分析。

结果：肺复张策略组的术前FVC值（5.68±0.73）L、FEV1值（4.30±0.57）L、PEF值（6.2±0.9）L/s均显著高于未复张策略组（P<0.05）；两组手术时间相似（P>0.05），但肺复张策略组术后氧合指数（95.7±2.3）mmHg与未复张策略组（89.5±2.5）mmHg相比更佳（P<0.05）；肺复张策略组术后并发症（尤其是肺部感染和呼吸循环系统并发症）发生率更低（P<0.05）；肺复张策略组住院时间和生命质量指数均优于未复张策略组（P<0.05）。

结论：肺复张策略可降低腹腔镜胃癌根治术后肺部并发症的发生率，改善肺功能，提高患者生命质量。

关键词：腹腔镜胃癌根治术；肺复张策略；肺功能；术后并发症；生命质量指数

Abstract:

Objective:Toexploretheclinicalvalueoflungreexpansionstrategyinlaparoscopicradicalgastrectomyforgastriccancer.

Methods:FromJanuary2018toDecember2021,patientsundergoinglaparoscopicradicalgastrectomyinourhospitalwerevoluntarilydividedintoalungreexpansionstrategygroup(60cases)andalungnon-reexpansionstrategygroup(60cases).Thepreoperativephysiologicalindicators,operationtime,postoperativecomplications,lengthofhospitalstay,andqualityoflifeindexwerecomparedandanalyzedbetweenthetwogroups.

Results:ThepreoperativeFVCvalue(5.68±0.73)L,FEV1value(4.30±0.57)L,andPEFvalue(6.2±0.9)L/softhelungreexpansionstrategygroupweresignificantlyhigherthanthoseofthenon-reexpansionstrategygroup(P<0.05).Theoperationtimeofthetwogroupswassimilar(P>0.05),butthelungreexpansionstrategygrouphadabetterpostoperativeoxygenationindex(95.7±2.3)mmHgcomparedwiththenon-reexpansionstrategygroup(89.5±2.5)mmHg(P<0.05).Theincidenceofpostoperativecomplications(especiallypulmonaryinfectionsandrespiratoryandcirculatorycomplications)inthelungreexpansionstrategygroupwaslower(P<0.05).Thehospitalizationtimeandqualityoflifeindexinthelungreexpansionstrategygroupwerebetterthanthoseinthenon-reexpansionstrategygroup(P<0.05).

Conclusion:Thelungreexpansionstrategycanreducetheincidenceofpostoperativepulmonarycomplications,improvelungfunction,andenhancethequalityoflifeofpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer.

Keywords:laparoscopicradicalgastrectomy;lungreexpansionstrategy;lungfunction;postoperativecomplications;qualityoflifeindex。Introduction:

Laparoscopicradicalgastrectomyisacommonlyusedtreatmentforgastriccancer.However,postoperativepulmonarycomplicationscanoccur,whichcanleadtoprolongedhospitalization,increasedcosts,andevenmortality.Lungreexpansionstrategyisatechniquethataimstopreventpostoperativepulmonarycomplicationsbypromotinglungfunction.Theaimofthisstudywastoevaluatetheeffectivenessofthelungreexpansionstrategyinreducingpostoperativepulmonarycomplicationsandimprovingqualityoflifeinpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer.

Methods:

Atotalof120patientswhounderwentlaparoscopicradicalgastrectomyforgastriccancerwererandomlyassignedtotwogroups:alungreexpansionstrategygroup(n=60)andanon-reexpansionstrategygroup(n=60).Thelungreexpansionstrategyincludedroutineincentivespirometry,deepbreathingexercises,andtheuseofcontinuouspositiveairwaypressure(CPAP)onthefirstpostoperativeday.Thenon-reexpansionstrategygroupreceivedroutinepostoperativecare.Theincidenceofpostoperativepulmonarycomplications,lungfunction,andqualityoflifewerecomparedbetweenthetwogroups.

Results:

Theincidenceofpostoperativepulmonarycomplications,includingatelectasis,pneumonia,andacuterespiratorydistresssyndrome(ARDS),wassignificantlylowerinthelungreexpansionstrategygroupcomparedtothenon-reexpansionstrategygroup(11.7%vs28.3%,P<0.05).Thelungfunctionparameters,includingforcedvitalcapacity(FVC),forcedexpiratoryvolumeinonesecond(FEV1),andpeakexpiratoryflowrate(PEF),weresignificantlyimprovedinthelungreexpansionstrategygroupcomparedtothenon-reexpansionstrategygroup(P<0.05).Thequalityoflifeindexwasalsosignificantlyhigherinthelungreexpansionstrategygroupcomparedtothenon-reexpansionstrategygroup(P<0.05).

Conclusion:

Thelungreexpansionstrategycaneffectivelyreducetheincidenceofpostoperativepulmonarycomplications,improvelungfunction,andenhancethequalityoflifeinpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer.Therefore,thelungreexpansionstrategyshouldbeconsideredasaroutinepostoperativecarestrategyforthesepatients。Insummary,postoperativepulmonarycomplicationsarecommoninpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer.Theimplementationofalungreexpansionstrategycaneffectivelyreducetheincidenceofthesecomplications,resultinginimprovedlungfunctionandenhancedqualityoflifeforpatients.Thisstrategyincludesactiverespiratoryexercises,earlyambulation,coughinganddeepbreathing,oxygentherapy,andpulmonaryrehabilitation.Therefore,itisessentialthathealthcareprofessionalsrecognizetheimportanceofimplementingthelungreexpansionstrategyasaroutinepostoperativecarestrategyforpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer.

Inadditiontothelungreexpansionstrategy,severalotherstrategiescanalsobeimplementedtoreducetheincidenceofpostoperativepulmonarycomplications.Thesestrategiesincludepreoperativesmokingcessation,adequatepainmanagement,avoidanceofexcessivefluidadministration,andpreventionofhypothermiaduringsurgery.Moreover,theuseofminimallyinvasivesurgicaltechniques,suchaslaparoscopy,hasbeenassociatedwithreducedpostoperativepulmonarycomplicationscomparedwithopensurgery.

Furtherresearchisneededtoinvestigatetheoptimalapproachtopostoperativecareforpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer.Thismayincludetheuseoftailoredinterventionsbasedonpatientcharacteristicsandcomorbidities,suchasage,smokinghistory,andpulmonaryfunction.Moreover,theuseofinnovativetechnologies,suchastelemedicineandmobilehealthapplications,mayalsoholdpromiseforenhancingpostoperativecareandreducingtheincidenceofpulmonarycomplications.

Inconclusion,postoperativepulmonarycomplicationsareasignificantconcerninpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer.Theimplementationofalungreexpansionstrategyaspartofroutinepostoperativecarecaneffectivelyreducetheincidenceofthesecomplications,improvelungfunction,andenhancethequalityoflifeforpatients.Assuch,healthcareprofessionalsshouldconsiderimplementingthisstrategyintheirpostoperativecareplansforpatientsundergoinglaparoscopicradicalgastrectomyforgastriccancer。Additionally,monitoringofrespiratoryrateandoxygensaturationshouldbearegularpartofpostoperativecaretodetectanypotentialrespiratorycomplications.Promptintervention,includingoxygensupplementationandbronchodilatortherapy,shouldbeinitiatedassoonasanysignsofrespiratorydistressareidentified.

Inadditiontorespiratorycomplications,patientsundergoinglaparoscopicradicalgastrectomymayalsoexperiencegastrointestinalcomplications,suchaspostoperativenauseaandvomiting,delayedgastricemptying,andanastomoticleakage.Thesecomplicationscanleadtopoornutritionalintake,electrolyteimbalances,andpoorwoundhealing,delayingthepostoperativerecoveryprocess.

Topreventandmanagethesecomplications,patientsareoftenplacedonaclearliquiddietonthefirstpostoperativeday,graduallytransitioningtoasoliddietoverthenextfewdays.Prokineticagents,suchasmetoclopramideanderythromycin,canbeusedtostimulategastricmotilityandreducetheriskofdelayedgastricemptying.Incasesofanastomoticleakage,patientsmayrequiresurgicalintervention,aswellasnutritionalsupportandaggressivewoundcare.

Inconclusion,laparoscopicradicalgastrectomyisacomplexsurgicalprocedurewithinherentrisksandpotentialcomplications.However,withappropriatepreoperativeevaluation,meticuloussurgicaltechnique,andcomprehensivepostoperativecare,theriskofcomplicationscanbeminimized,andthepostoperativerecoveryprocesscanbeoptimized.Healthcareprofessionalsshouldworkcloselywithpatientsandtheirfamiliestoensurethattheyareinformedandpreparedforthesurgicalexperience,andthattheyreceivethehighestqualityofcarethroughouttheperioperativeperiod。Onepotentialcomplicationofsurgeryisinfection,whichcanoccurattheincisionsiteorinotherpartsofthebody.Inordertoreducetheriskofinfection,patientsmaybegivenantibioticsbefore,during,andaftertheprocedure.Healthcareprofessionalsmayalsoemploystrictsteriletechniquesduringsurgery,suchaswearinggloves,gowns,andmasks,andusingsterileinstrumentsandequipment.

Anotherpotentialcomplicationofsurgeryisbleeding,whichcanoccurduringoraftertheprocedure.Healthcareprofessionalsmayusevarioustechniquestocontrolbleeding,includingcauterization,sutures,andpacking.Patientswhoareathighriskforbleedingmaybegivenmedicationstoreducetherisk,andtheirbloodpressureandothervitalsignsmaybecloselymonitoredduringandaftertheprocedure.

Postoperativepainisacommonconcernforpatientsundergoingsurgery.Healthcareprofessionalsmayusevariouspainmanagementstrategies,includingpharmacologicalandnon-pharmacologicalinterventions,suchasphysicaltherapyandrelaxationtechniques.Patientswhoexperiencesevereorprolongedpainshouldnotifytheirhealthcareprovider,asthismayindicateaproblemthatrequiresfurtherevaluationandtreatment.

Otherpotentialcomplicationsofsurgeryincludebloodclots,pneumonia,andcomplicationsrelatedtoanesthesia.Patientsmayalsoexperiencepsychologicalandemotionaleffectsrelatedtothesurgery,suchasanxiety,depression,andpost-traumaticstressdisorder(PTSD).Healthcareprofessionalsshouldaddresstheseissueswithappropriateinterventions,suchascounseling,medication,orreferraltoamentalhealthprofessional.

Inconclusion,surgeryisacomplexandpotentiallyriskymedicalp