持续气道正压对胸腹腔镜联合食管癌根治术后肺损伤的影响  

Continuous positive airway pressure alleviates lung injury after thoracoscopic and laparoscopic surgery for esophageal carcinoma: report of 50 cases

作　　者：郝涌刚[1] 王萍[1] 刘丹彦[1] 

机构地区：[1]重庆医科大学附属第一医院麻醉科,重庆400016

出　　处：《第三军医大学学报》2015年第23期2378-2381,共4页Journal of Third Military Medical University

基　　金：重庆市卫生局课题(2011-2-119);国家临床重点专科建设项目(财社〔2011〕170号);重庆医学重点学科建设项目(渝卫科教〔2007〕2号)~~

摘　　要：目的 观察单肺通气时,萎陷侧肺持续气道正压（continuous positive airway pressure,CPAP）对胸腹腔镜联合食管癌根治术后肺损伤的影响。方法 择期行胸腹腔镜联合食管癌根治术患者50例,ASA评分Ⅱ~Ⅲ级,年龄40~75岁,体质指数（BMI）18~27,按随机数字表法分为2组（n=25）：对照组,即单肺通气时萎陷侧肺及气道向大气开放;CPAP组,即单肺通气时向萎陷侧肺持续输送纯氧维持萎陷侧肺及气道压力为6 cm H2O。分别于T1（麻醉开始前）、T2（单肺通气结束时）和T3（术后24 h）抽取患者的静脉血3 m L,用ELISA法检测血清晚期糖基化代谢产物（soluble receptor of advanced glycation end-products,sRAGE）和KL-6（krebs.von den Iungen-6）水平,同时抽取动脉血2 m L行血气分析,并计算氧合指数（oxygenation index,OI）。结果 氧合指数：对照组、CPAP组于T2、T3时点,氧合指数比T1时点均显著降低（P〈0.05）;在T2时点,CPAP组氧合指数比对照组显著升高（P〈0.05）。sRAGE和KL-6水平：CPAP组和对照组在T3时点与T1时点、T2时点比较sRAGE和KL-6水平均显著升高（P〈0.05）;在T3时点,与对照组比较,CPAP组sRAGE和KL-6水平显著降低（P〈0.05）。结论单肺通气时萎陷侧肺保持持续气道正压能减轻胸腹腔镜联合食管癌根治术所致肺损伤。Objective To investigate the effect of continuous positive airway pressure （CPAP） in collapsed lung on the lung injury after the thoracoscopic and laparoscopic surgery for esophageal carcinoma. Methods Fifty esophageal carcinoma patients （ASA grade II to III, aged 40 to 75, with body mass index of 18 to 27 ） undergoing selective thoracoscopic and laparoscopic esophagectomy in our hospital were prospectively enrolled in this study. They were randomly divided into control group （n = 25, the collapsed lung directly connected to the outside air in one lung ventilation） and CPAP group （n = 25, application of 6 cmH20 CPAP to the collapsed lung during one-lung ventilation ）. Serum levels of soluble receptor of advanced glycation end-products （sRAGE） and krebs von den lungen-6 （KL-6） were detected with ELISA at 3 time points, that is, before operation （T1）, at the end of one lung ventilation （T2）, and 24 h after operation （T3）. Arterial blood gas analysis was carried out to calculate the oxygenation index （0I）. Results The OI values were significantly decreased in both groups at T2 and T3 than those at T1 （ P 〈 0.05 ） , and it was significantly higher at T2 in the CPAP group than the control （ P 〈 0.05 ）. sRAGE and KL-6 levels were markedly elevated in both groups at T3 than T1 and T2 （ P 〈 0.05 ）. sRAGE and KL-6 were significantly decreased in the CPAP group than control at T3 （P 〈 0.05）. Conclusion CPAP in collapsed lun during lung ventilation might reduce the lung injury after the thoracoscopic and laparoscopic surgery for esophageal carcinoma.

关 键 词：持续气道正压 肺损伤 血清晚期糖基化代谢产物 KL-6 

分 类 号：R563[医药卫生—呼吸系统] R572[医药卫生—内科学]