保护性通气策略联合糖皮质激素用于小儿腹腔镜手术机械通气所致肺损伤效果观察  

Effects of protective ventilation strategy and glucocorticoids in treatment of children mechanical ventilation-induced lung injury in laparoscopic surgery

作　　者：孙庆梅[1] 张洪波[2] 郭永民[1] 刘德杰[1] 

机构地区：[1]山东大学齐鲁医院,济南250012 [2]馆陶县人民医院

出　　处：《山东医药》2016年第20期12-14,共3页Shandong Medical Journal

基　　金：山东省自然科学基金资助项目(ZR2012HM027)

摘　　要：目的探讨保护性通气策略联合糖皮质激素对小儿腹腔镜手术机械通气所致肺损伤的影响。方法选择择期行腹腔镜肾盂成形术患儿45例,随机分为Ⅰ、Ⅱ、Ⅲ组,每组15例。所有患儿行气管插管全身麻醉,全程机械通气下进行手术。Ⅰ组给予常规通气策略,Ⅱ组给予保护性通气策略,Ⅲ组给予保护性通气策略联合应用糖皮质激素。分别于气腹前5 min,气腹后15、30、45 min及放气后10 min,观察各组血流动力学指标(HR、MAP)、呼吸力学指标[动态肺顺应性(Cdyn)],并抽取动脉血检测PaCO_2、pH及血浆IL-8、中性粒细胞弹性蛋白酶(NE)。记录三组气腹时间、手术时间及住院时间。结果与气腹前5 min比较,三组气腹后各时点PaCO_2、IL-8、NE均显著增高,p H、Cdyn均显著降低(P均<0.05);Ⅱ、Ⅲ组气腹后各时点PaCO_2、pH、Cdyn及血浆IL-8、NE水平与Ⅰ组同时点比较差异均有统计学意义,且Ⅲ组各指标变化较Ⅱ组更明显(P均<0.05)。三组气腹时间、手术时间、住院时间比较差异均无统计学意义(P均>0.05)。结论保护性通气策略联合糖皮质激素可减轻小儿腹腔镜手术机械通气所致肺损伤程度。Objective To observe the effects of protective ventilation strategy and glucocorticoids in treatment of children mechanical ventilation-induced lung injury in laparoscopic surgery. Methods Forty-five cases children undergoing selective laparoscopic pyeloplasty were randomly divided into three groups（ group Ⅰ,group Ⅱ,group Ⅲ）,and each group had 15 cases. All children received tracheal intubation under general anesthesia,and ventilation by machine during the whole process. Group I received conventional ventilation strategy,group II received protective ventilation strategy and group Ⅲ were given protective ventilation strategy combined with glucocorticoids. Each hemodynamic index（ HR,MAP）and respiratory mechanics index（ Cdyn） were recorded,meanhwhile,the arterial blood was extracted to monitor blood gas analysis（ PaCO_2,pH） as well as the levels of plasma IL-8 and neutrophil elastase（ NE） at 5 minutes before pneumoperitoneum,15 min,30 min and 45 min after peneumopertoneum and at 10 min after deflation. Results Compared with the time at 5 minutes before pneumoperitoneum,the children＇s PaCO_2,IL-8 and NE were significantly increased,the PH value and Cdyn was decreased significantly at each time after pneumoperitoneum in all groups（ all P〈 0. 05）. Significant difference was found in the children＇s PaCO_2,pH,Cdyn,IL-8 and NE between groups Ⅱ,Ⅲ and group Ⅰ at each time points and the changes in the group Ⅲ were more significant（ all P〈 0. 05）. There was no statistical difference in the pneumoperitoneum,operation time and hospital stays（ all P〉 0. 05）. Conclusion The protective ventilation strategy and glucocoticoids can reduce the degree of children mechanical ventilation-induced lung injury in laparoscopic surgery.

关 键 词：保护性通气 肺损伤 腹腔镜手术 糖皮质激素 

分 类 号：R563[医药卫生—呼吸系统]