摘要目的:评价肢体远隔缺血预处理联合后处理对老年患者胸腔镜肺癌根治术后肺部并发症的影响。方法:择期行胸腔镜肺癌根治术老年患者80例，年龄65～79岁，身高155～180 cm，体重45～80 kg，ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组( n＝40)：对照组(C组)和远隔缺血预处理联合后处理组(R组)。R组分别于单肺通气前30 min和单肺通气结束前30 min在患者右上肢上臂采用水银血压计袖带给予3个循环的5 min缺血(200 mmHg)及5 min再灌注(袖带完全放气)处理。C组将袖带绑于患者右上肢，但不进行充气及放气处理。记录2组患者术后72 h内肺部并发症的发生情况。分别于术后1和2 d时采用康复质量评分量表-15 (QoR-15)评估患者术后早期康复质量。分别于术前1 d、术后1和3 d时记录患者白细胞和中性粒细胞计数及中性粒细胞百分比。记录PACU停留时间和术后住院时间。 结果:与C组比较，R组术后72 h内肺部并发症发生率降低，术后1和2 d时QoR-15评分升高，术后1和3 d时白细胞计数、中性粒细胞计数和中性粒细胞百分比降低，PACU停留时间和术后住院时间缩短( P<0.05)。 结论:肢体远隔缺血预处理联合后处理可降低胸腔镜肺癌根治术老年患者术后肺部并发症发生风险，有利于早期康复。

abstractsObjective:To evaluate the effect of remote ischemic preconditioning (RIPC) combined with postconditioning (RIPostC) on postoperative pulmonary complications in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-79 yr, with height 155-180 cm, weighing 45-80 kg, were divided into 2 groups ( n=40 each) by the random number table method: control group (group C) and RIPC combined with RIPostC group (group R). RIPC was induced by 3 cycles of 5 min ischemia (cuff inflation to 200 mmHg) followed by 5 min reperfusion (cuff deflation to 0 mmHg) though applying a mercury sphygmomanometer adult cuff to the right upper extremity at 30 min before one-lung ventilation and 30 min before the end of one-lung ventilation in group R. The adult cuff was only bound to the right upper extremity without inflation and deflation in group C. The occurrence of pulmonary complications was recorded within 72 h after operation in both groups.The Quality of Recovery-15 score was used to assess the early postoperative quality of recovery on 1 and 2 days after operation.The number of white blood cells and neutrophils and percentage of neutrophils were recorded at 1 day before surgery and 1 and 3 days after surgery.The postanesthesia care unit stay time and hospital stay time were recorded. Results:Compared with group C, the incidence of pulmonary complications was significantly decreased within 72 h after operation, Quality of Recovery-15 scores were increased at 1 and 2 days after operation, the number of white blood cells and neutrophils and percentage of neutrophils were decreased at 1 and 3 days after operation, and the postanesthesia care unit stay time and postoperative hospital stay time were shortened in group R ( P<0.05). Conclusion:RIPC combined with RIPostC can decrease the risk of postoperative pulmonary complications and is helpful for early postoperative rehabilitation in elderly patients undergoing thoracoscopic radical surgery for lung cancer.