肺保护性通气对肝移植术后患者急性肺损伤的影响  

Effect of lung-protective ventilation on acute lung injury after liver transplantation

作　　者：董兰[1] 安丽娜[1] 岳阳[1] 李占军[1] 陈晓阳[1] 韩曙君[1] 

机构地区：[1]武警总医院麻醉科,北京市100039

出　　处：《中华麻醉学杂志》2017年第4期404-407,共4页Chinese Journal of Anesthesiology

基　　金：国家高技术研究发展计划（863计划）（2012AA021006）

摘　　要：目的评价肺保护性通气对肝移植术后患者急性肺损伤的影响。方法选择原位肝移植术患者60例，性别不限，年龄21～64岁，BMI 18～28 kg/m^2，ASA分级Ⅱ-Ⅳ级。采用随机数字表法分为2组（n＝30）：常规机械通气组（CMV组）和肺保护性通气组（LPV组）。LPV组通气参数：VT 6～8 ml/kg、通气频率10～15次/min、PEEP 3～10 cmH2O，每2 h进行1次肺复张术。于切皮前（T1）、无肝前期3 h（T2）、无肝期30 min（T3）、新肝期2 h（T4）及新肝期4 h（T5）收集支气管肺泡灌洗液（BALF），同时采集桡动脉血标本，采用ELISA法测定BALF和血清TNF-α和IL-8浓度。于术后2 h（T6）、气管拔管前（T7）及术后2 d（T8）时采集桡动脉血标本，行血气分析，计算氧合指数，于T1～T8时采用ELISA法测定血清克拉拉细胞分泌蛋白16、表面活性蛋白及高级糖基化终末产物可溶性受体浓度。记录术后苏醒时间、气管拔管时间、ICU停留时间和急性肺损伤发生情况。结果与CMV组比较，LPV组气管拔管时间缩短，T2、T3、T6、T7时血清克拉拉细胞分泌蛋白16浓度降低，T5时血清表面活性蛋白浓度降低，T5和T6时血清高级糖基化终末产物可容性受体浓度降低（P〈0.05），各时点血清和BALF TNF-α和IL-8浓度、术后急性肺损伤发生率、氧合指数、苏醒时间、ICU停留时间差异无统计学意义（P〉0.05）。结论肺保护性通气虽然未降低肝移植术患者术后急性肺损伤的发生，但在一定程度上减轻了肺组织损伤。Objective To evaluate the effects of lung-protective ventilation on acute lung injury after liver transplantation.Methods Sixty patients of both sexes, aged 21-64 yr, with body mass index of 18-28 kg/m^2, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, scheduled for elective orthotopic liver transplantation, were divided into 2 groups（n=30 each）using a random number table： conventional mechanical ventilation group（group CMV）and lung-protective ventilation group（group LPV）. In group LPV, the patients were mechanically ventilated（tidal volume 6-8 ml/kg, respiratory rate 10-15 breaths/min, positive end-expiratory pressure 3-10 cmH2O）, and lung recruitment maneuver was performed every 2 h. Before skin incision（T1）, at 3 h of preanhepatic phase（T2）, at 30 min of anhepatic phase（T3）and at 2 and 4 h of neohepatic phase（T4, 5）, bronchoalveolar lavage fluid（BALF）was collected and blood samples from the radial artery were simultaneously collected for determination of tumor necrosis factor-alpha and interleukin-8 concentrations in BALF and serum by enzyme-linked immunosorbent assay.At 2 h after operation（T6）, before tracheal extubation（T7）and at 2 days after operation（T8）, blood samples from the radial artery were collected for blood gas analysis, and oxygenation index was calculated.The concentrations of serum Clara cell secretory protein 16, surfactant protein D and soluble receptor for advanced glycation end-products were determined at T1-T8 using enzyme-linked immunosorbent assay.The postoperative emergence time, extubation time, duration of intensive care unit stay and development of acute lung injury were recorded.Results Compared with group CMV, the extubation time was significantly shortened, serum concentrations of Clara cell secretory protein 16 at T2, T3, T6 and T7, serum surfactant protein D concentrations at T5 and serum concentrations of soluable receptor for advanced glycation end-products at T5 and T6 were decreased（P〈0.05）, and no sig

关 键 词：呼吸 人工 呼吸窘迫综合征 成人 肝移植 

分 类 号：R614[医药卫生—麻醉学]