不同通气模式对腹腔肿瘤根治术老年患者围术期炎性反应的影响  

Effects of different models of mechanical ventilation on perioperative inflammatory response in elderly pa- tients undergoing radical surgery for abdominal tumors

作　　者：林高翔[1] 刘冠锦[2] 庞宏宣[1] 谭永星[1] 张文斌[1] 

机构地区：[1]桂林医学院附属医院麻醉科,541004 [2]桂林医学院研究生院

出　　处：《中华麻醉学杂志》2011年第12期1465-1468,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价不同通气模式对腹腔肿瘤根治术老年患者围术期炎性反应的影响。方法择期拟行腹腔肿瘤根治术的患者60例，年龄65～80岁，性别不限，ASA分级I或Ⅱ级，采用随机数字表法，将其随机分为3组（n=20）：低vT联合低PEEP通气组（A组）、高vT通气组（B组）和低vT联合高PEEP通气组（C组）。静脉注射咪达唑仑、舒芬太尼、依托咪酯和罗库溴铵麻醉诱导，气管插管后行机械通气，A组VT为6ml／kg，PEEP为5cm H2O；B组VT为10ml／kg，PEEP为0；C组VT为6ml／kg，PEEP为8cmH2O，维持PETCO2 35～45mmHg。静脉输注舒芬太尼、维库溴铵和依托咪酯维持麻醉。于麻醉诱导前（L）、切皮后10min（T1）、机械通气1h（T2）、机械通气2h（T3）和拔除气管导管后15min（L）时采集静脉血样，采用ELISA法测定血清IL-10、IL-8和TNF—a的浓度。术毕时采集动脉血样，进行动脉血气分析。术后1d记录肺部并发症的发生情况。结果与A组比较，B组L时血清IL-10浓度升高，T1、T2和T4时血清IL-8浓度升高，T1～T4时血清TNF—d浓度升高，PaO2和PaO2／FiO2降低，A—aDO2升高，c组T1～T4时血清IL-10浓度升高，T4时血清IL-8和TNF—d的浓度升高，PaO2／FiO2降低（P〈0．05）；与B组比较，c组T1～T3时血清TNF—a浓度升高（P〈0．05），血气分析指标差异无统计学意义（P〉0．05）。术后仅B组发生肺不张1例。结论低vT联合低PEEP通气可改善腹腔肿瘤根治术老年患者的氧合，减轻全身炎性反应。Objective To investigate the effect of different models of mechanical ventilation on perioperative inflammatory response in elderly patients undergoing radical surgery for abdominal tumors. Methods Sixty ASA Ⅱ or Ⅲ elderly patients aged 65-80 yr of both sexes undegoing radical surgery for abdominal tumors were randomly divided into 3 groups （ n = 20 each） ： group A low VT and low PEEP mechanical ventilation （ VT = 6 ml/kg, PEEP= 5 cm H20） ; group B high VT mechanical ventilation （VT = 10 ml/kg, PEEP= 0） ; group C low VT and high PEEP mechanical ventilation （VT = 6 ml/kg, PEEP = 8 cm H2 O）. Anesthesia was induced with mida- zolam, sufentanil, etomidate and vecuronium and maintained with sufentanil, vecuronimn and etomidate. PET CO2 was maintained at 35-45 mm Hg. Arterial blood samples were taken for deterulination of serum concentrations of IL-10, IL-8 and TNF-a by ELISA before anesthesia induction（T0）, at 10 rain after the start of surgery（T1） ,at 1 h and 2 h of mechanical ventilation（T2 ,T3 ）and at 15 rain after tracheal extubation （T4）. Arterial blood gas was analyzed at the end of operation and the complications of puhnonary were recorded at 1 d after operation. Results Compared with group A, serum concentration of IL-10 was significantly increased at T4 and serum concentration of IL-8 was increased at Ti ,T2 and T4 , serum concentration of TNF-a was increased at T1-T4 ,PaO2 and PaO2/FiO2 were decreased and A-aDO2 was increased in group B, serum concentration of IL-10 was increased at T2-T4 and serum concentrations of IL-8 and TNF-a were increased at T4 and PaO2/FiO2 was decreased in group C（ P 〈 0.05）. Compared with group B, serum concentration of TNF-a was significantly increased at T t-T3 in group C （ P 〈 0.05 ）. Only one atelectasis was occurred in group B. Conclusion Mechanical ventilation with low VT combined with low PEEP can improve oxygenation, decrease intlammatory response in elderly patients undergoing radical surgery for abdominal tumors.

关 键 词：潮气量 正压呼吸 炎症 老年人 

分 类 号：R614[医药卫生—麻醉学]