潮气量对婴儿循环紧闭麻醉后支气管肺泡灌洗液中PMN、TNF-α、IL-6及IL-8含量的影响  

Influences of Tidal Volume on Contents of PMN,TNF-α,IL-6 and IL-8 in Bronchoalveolar Lavage Fluid After Closed Circuit Anesthesia in Infants

作　　者：沈晓署[1] 袁力勇[1] 甘果[1] 王霞民[1] 

机构地区：[1]宁波市妇女儿童医院麻醉科,315012

出　　处：《医学研究杂志》2008年第4期41-44,共4页Journal of Medical Research

基　　金：宁波市医学科技项目(2005538)

摘　　要：目的寻求婴儿循环紧闭麻醉期间合适的潮气量以减少机械通气对患儿肺部的损伤。方法择期行骨科手术婴儿50例,随机分为常规潮气量(12～15ml/kg)T组(n=25)和小潮气量(7～8ml/kg)L组(n=25)。于气管插管后(T1)及拔管前(T2)分别收集患儿的BALF。EASIA法、EIA法分别测定BALF中IL-6、IL-8及TNF-α含量;赖氏法染色,进行PMN计数。术中连续监测SpO2、动脉血压、PetCO2、定期动脉血气分析。观察患儿苏醒时间和术后肺部并发症。结果机械通气30min、60min、120min及拔管前L组中PaCO2、PetCO2较T组升高(P<0.05)、pH值下降(P<0.05);T1时两组BALF中PMN、TNF-α、IL-6、IL-8含量无显著性差异;T组T2时与T1时比、与L组T2时比,BALF中各炎性物质增加(P<0.05);L组T2时与T1时比,BALF中各炎性物质相似(P>0.05);T组咳嗽发生率(78%)、气道分泌物量(87±11ml)分别高于L组(22%)、(31±15ml)(P<0.05)。结论婴儿实施小潮气量机械通气可以减少BALF中炎性物质的释放,可能有益于减少循环紧闭麻醉后肺部并发症。Objective The author seeked the suitable tidal volume in order to decrease mechanical ventilation - induced lung injury during closed circuit anesthesia in infants. Methodes 50 infants who practiced selective orthopedics operation randomly divided into tradi- tional mode （ 12 - 15 ml/kg, groupT, n = 25 ） and low tidal volumes （ 7 - 8ml/kg, groupL, n = 25 ）. The bronchoalveolar lavage fluid of intants were collected immediately after tracheal intubation （T1） and before tracheal extubation, respectively. Interleukin -6 and interleukin - 8 in the bronchoalveolar lavage fluid were determined by enhancement solid - phase enzyme immunoassay action（EASIA） , TNF - α in the bronchoalveolar lavage fluid were determined by euzymelinked immunosorbent assay （ EIA）. The numbers of polymorphonuclear neutro- phils in the bronchoalveolar lavage fluid of intants were examined. The infants＇ SpO2 , arterial blood pressure and PetCO2 were monitored continuously. Arterial blood gas was analysised. The time of analepsia and complications of lung were observed after operation. Results PaCO2 ,PetCO2 in groupL were higher than that in groupT,pH in groupL lower than that in groupT at 30 min ,60 min,120 min after mechanical ventilation and before extubation,respectively. The contents of PMN, TNF -α, IL -6 and IL -8 in BALF collected at T2 more than that at T~ in groupT. The contents of PMN, TNF -α, IL - 6 and IL - 8 in BALF in groupL less than that in groupT at T2 （ P 〈 0. 05 ）. The incidence of cough and the quantity of secretion substance of airway in groupT were higher than that in groupL,respectively（P 〈0. 05）. Conclusion Low tidal volumes during closed circuit anesthesia in infants could decrease the release of inflammatory substances in BALF,and might beneficial to decrease the incidences of complications in lung.

关 键 词：潮气量 婴儿 循环紧闭麻醉 支气管肺泡灌洗液 多形核中性白细胞 肿瘤坏死因子-α 白细胞介素-6 白细胞介素-8 

分 类 号：R563.8[医药卫生—呼吸系统] R725.622.5[医药卫生—内科学]