允许性高碳酸血症对行腹腔镜下胃癌根治术患者外周血炎性因子的影响  

The effects of ventilation strategy of permissive hypercapnia on the expression of inflammatory mediators in the patients received laparoscopic radical gastrectomy

作　　者：陈雷[1] 陶建平[2] 

机构地区：[1]浙江省绍兴市人民医院麻醉科,312000 [2]昆明医学院第二附属医院麻醉科

出　　处：《中国医师进修杂志》2009年第4期24-26,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨允许性高碳酸血症的通气策略在腹腔镜下胃癌根治术麻醉中的应用价值，观察其对患者外周血炎性因子的影响。方法选择行腹腔镜下胃癌根治术患者36例，随机分为两组：对照组和试验组，每组各18例。对照组行传统的通气策略：呼气末二氧化碳分压（P盯c0：）为34．5～45．0mmHg（1mmHg=0．133kPa），pH值为7-35～7．45；试验组行允许性高碳酸血症的通气策略：PnCO2为49．5～60．0mmHg，pH〉7．20。分别于麻醉前（T0）、手术1h（T1）、手术3h（T2）、术毕（T3）四个时间点检测两组患者外周血炎性因子的变化。结果B、B时间点对照组白细胞介素（IL）-8、IL-6、肿瘤坏死因子（TNF）-α[（96．732±3．173）ug/L和（107．767±3．654）ug／L、（0．273±0．009）ng／L和（0．287±0．008）ng／L、（1．443±0．086）ug／L和（1．614±0．107）ug／L]与试验组[（91．771±4．332）ug／L和（97．682±4．998）ug／L、（0．231±0．008）ng／L和（0．241±0．006）ng／L、（1．268±0．066）ug／L和（1．428±0．058）ug／L]比较均明显增高（P〈0．05或〈0．01），平均动脉压、动脉血氧分压、心率都保持相对稳定。结论腹腔镜下胃癌根治术麻醉中，允许性高碳酸血症的通气策略能减少炎性因子的释放，可能是一种较好的通气策略。Objective To investigate the effects of ventilation strategy of permissive hypereapnia on the expression of inflammatory mediators in the patients received laparoscopic radical gastrectomy. Methods Thirty-six patients received laparoscopic radical gastrectomy were randomly divided into two groups： control group and experiment ~7oilp. The patients in control group received conventional ventilation strategy [ partial pressure of carbon dioxide in endexpiratory gas （PETCO2） 34.5-45.0 mmHg （ 1 mm Hg = 0. 133 kPa）, pH 7.35-7.45 ], and patients in experiment group received ventilation strategy of permissive hypereapnia（PET CO2 49.5-60.0 mm Hg, pH 〉 7.20）. Blood samples were collected respectively from the peripheral vein before anesthesia induction （T0）, 1 h （T1）, 3 h （T2） after operation and when operation finished （T3） for the assessment of intedeukin （IL）-8, IL-6, tumor necrosis factor （TNF）-α. Results The levels of IL-8, IL-6, TNF-ot at T2, T3 were higher in control group [（96.732 ±3.173） ug/L and （107.767 ±3.654） ug/L, （0.273 ±0.009） ng/L and （0.287 ±0.008） ng/L,（1.443±0.086） ug/Land （1.614±0.107） ug/L] than those in experiment group [（91.771 ± 4.332） ug/L and （97.682 ± 4.998）ug/L, （0.231 ± 0.008） ng/L and （0.241 ±0.006） ng/L,（1.268 ±0.066）ug/L and （1.428±0.058） ug/L]（P〈0.05 or 〈0.01）, mean arterial pressure, partial pressure of oxygen in artery and heart rate were relative stabilization. Conclusions Ventilation strategy of permissive hypercapnia can reduce the released amount of inflammatory mediators and may be advantageous for the patients received laparoscopic radical gastrectomy.

关 键 词：麻醉 腹腔镜 胃肿瘤 高碳酸血 炎性因子 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]