允许性高碳酸血症对单肺通气后肺功能及萎陷侧肺炎症反应的影响  

Effect of permissive hypercapnia on pulmonary function and inflammatory response of the collapsed lung

作　　者：何明枫[1] 陈宇[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2015年第12期1172-1175,共4页Journal of Clinical Anesthesiology

摘　　要：目的：观察允许性高碳酸血症对胸腔镜下肺叶切除术患者单肺通气后肺功能及萎陷侧肺炎症反应的影响。方法拟于胸腔镜下行肺叶切除术的患者50例,ASA Ⅱ或Ⅲ级,年龄38~65岁。患者随机分为两组,每组25例。术中维持 PaCO235~45 mm Hg（C 组）和55~65 mm Hg（H组）。分别于单肺通气前1 min（T1）、单肺通气后30 min（T2）、萎陷肺复张后30 min（T3）抽取动脉血5 ml,行动脉血气分析并计算呼吸指数（RI）；收集外周静脉血及萎陷侧肺下叶肺泡灌洗液,检测TNF-α、IL-6和 IL-10水平；记录气道峰压、潮气量、气道平台压,并计算动态肺顺应性（Cdyn）。结果与C 组比较,T2时 H 组气道峰压明显降低（P 〈0.05）；T2、T3时 H 组萎陷侧肺泡灌洗液 IL-10水平和 Cdyn 明显升高（P 〈0.05）,TNF-α、IL-6水平、RI 明显降低（P 〈0.05）。结论允许性高碳酸血症能有效抑制肺叶切除术患者单肺通气后萎陷侧肺的炎症反应,改善肺脏弥散功能及顺应性。Objective To evaluate the effect of permissive hypercapnia on pulmonary function and in-flammatory responses of the collapsed lung of patients underwent video-assisted pulmonary lobectomy after one-lung ventilation.Methods Fifty patients,aged 38-65 years,ASA Ⅱ or Ⅲ,including 30 males and 20 females,scheduled for video-assisted pulmonary lobectomy were selected and divided into two groups ran-domly,with 25 patients in each group.During the surgery,PaCO2 of patients in group C were maintained during 35 to 45 mm Hg,while in group H the value were 55 to 65 mm Hg.The arterial blood samples were collected at 1 min before one-lung ventilate （T1 ）,30 min after one-lung ventilate （T2 ）and 30 min after re-flow of the collapsed lung （T3 ）for arterial blood gas analysis,then the respiratory index of each patient was evaluated.Peripheral venous blood and bronchoalveolar lavage fluid draw from left lower lobar of the col-lapsed lung were collected to evaluate the levels of TNF-α,IL-6,and IL-10 at T1 ,T2 and T3 .The peak in-spiratory pressure,plateau pressure and tidal volume were also recorded to calculate lung dynamic compli-ance.Results Compared to group C,peak inspiratory pressure of group H was significantly higher;the IL-10 level of bronchoalveolar lavage fluid of the collapsed lung and the pulmonary dynamic compliance of group H were significantly higher at T2 and T3 ,and the concentrations of TNF-α,IL-6 of bronchoalveolar lavage fluid,the peak pressure,and respiratory index of group H were lower significantly at the same point of time （P 〈0.05）.Conclusion Permissive hypercapnia would inhibit inflammation response of collapsed lung after one-lung ventilation effectively,improve lung diffusion capacity and pulmonary compliance.

关 键 词：允许性高碳酸血症 单肺通气 炎症反应 

分 类 号：R614[医药卫生—麻醉学]