不同机械通气模式对老年腹部手术患者细胞因子的影响  

Effects of different mechanical ventilation modes on cytokines in elderly patients undergoing abdominal surgery

作　　者：杨韩[1] 方光光[1] 黄绍农[1] 

机构地区：[1]深圳市第二人民医院麻醉科,广东深圳518035

出　　处：《岭南现代临床外科》2017年第3期313-318,共6页Lingnan Modern Clinics in Surgery

基　　金：深圳市科技创新委员会资助项目(JCYJ20150330102720164)

摘　　要：目的探讨不同机械通气模式对于老年腹部手术患者细胞因子的影响。方法 72例择期进行腹部手术全麻机械通气的老年患者(年龄>65岁)分为6组,每组12例。A组:VCV(Vt 6 m L/kg)+PEEP 8 mm Hg+auto-flow模式;B组:VCV(Vt 6 m L/kg)+PEEP 8 mm Hg+const-flow模式;C组:VCV(Vt 6 m L/kg)+PEEP 12 mm Hg+auto-flow模式;D组:VCV(Vt 6 m L/kg)+PEEP 12mm Hg+const-flow模式;E组:VCV(Vt 10 m L/kg)+auto-flow模式;F组:VCV(Vt 10 m L/kg)+const-flow模式。6组患者全身麻醉气管插管后,均予以VCV(Vt 6 m L/kg)+const-flow模式通气60 min,再按分组的通气模式进行通气,总通气时间大于5 h。在通气1 h及5 h两个时间点,抽取静脉血和支气管肺泡灌洗液检测IL-8、IL-10、MMP-9、SP-A以及SF浓度。结果大潮气量组(E、F两组)较小潮气量四组(A、B、C、D四组)通气5 h后,血与BALF中测定的IL-8、MMP-9浓度以及血中测定的SP-A、SF浓度明显升高(P<0.05),血与BALF中测定的IL-10浓度以及BALF中测定的SP-A浓度明显降低(P<0.05)。通气5 h后F组较E组,血及BALF中IL-8以及MMP-9、血SF、血SP-A更高(P<0.05),而BALF中SP-A则更低(P<0.05)。结论 (1)大潮气量机械通气较小潮气量机械通气而言,更有利于促进IL-8、MMP-9、SF的分泌,抑制IL-10的释放,BALF中SP-A下降,血中SP-A升高,进一步加剧了VILI的程度。(2)就老年(年龄>65岁)腹部手术患者而言,围手术期以VCV(Vt6 m L/kg)+PEEP 12 mm Hg+auto-flow模式机械通气较其他五种通气模式,更有利于减轻肺组织急性炎症反应及氧化应激反应的激活,减轻机械通气所致生物伤,从而减轻VILI的程度。Objective To investigate the effect of different mechanical ventilation modes on cytokines in elderly patients undergoing abdominal surgery. Method Seventy-two cases of elderly patients(aged>65 years)who underwent abdominal surgery under general anesthesia were assigned to six groups(n=12). Group A:VCV(Vt 6 ml/kg)+PEEP 8 mm Hg+auto flow;group B:VCV(Vt 6 ml/kg)+PEEP 8 mm Hg+const flow;group C:VCV(Vt 6 ml/kg)+PEEP 12 mm Hg+auto flow;group D:VCV(Vt 6 ml/kg)+ PEEP 12 mm Hg+const flow;group E:VCV(Vt 10 ml/kg)+auto flow;group F:VCV(Vt 10 ml/kg)+const flow. The six groups of patients with general anesthesia after tracheal intubation,were given VCV(Vt 6 ml/kg)+const flow mode ventilation for 60 minutes,and then grouped according to the mode of ventilation,total ventilation time greater than 5 hours. The IL-8,IL-10,MMP-9,SP-A and SF concentrations were measured in venous blood and bronchoalveolar lavage fluid at two time points of 1 hours and 5 hours. Results Compared with the high tidal volume groups(group E,F)and the low tidal volume groups(group A,B,C,D)after 5 hours ventilation,the concentration of IL-8,MMP-9 in blood and BALF and the concentration of SP-A and SF in blood were increased significantly(P<0.05),the concentration of IL-10 and SP-A in BALF and the concentration of IL-10 in blood were decreased significantly(P<0.05). The concentration of IL-8 and MMP-9 in blood and BALF and the concentration of SF and SP-A in blood were higher in the F group than in the E group after 5 hours of ventilation(P<0.05),while the concentration of SP-A in the BALF group was lower(P<0.05). Conclusion Firstly,compared with low tidal volume mechanical ventilation,the high volume mechanical ventilation is more conducive to promoting the secretion of IL-8,MMP-9 and SF,inhibiting the release of IL-10,the decrease of SP-A in BALF,the increase of SP-A in blood,further intensify the degree of VILI. Secondly,in the elderly(aged>65 years)patients undergoing abdominal operation,the perioperative period of mechanical ventilation with VCV(Vt 6

关 键 词：机械通气模式 自动变流 老年腹部手术 细胞因子 

分 类 号：R614[医药卫生—麻醉学]