机械通气中吸入不同氧浓度对正常肺动脉血氧分压及炎症介质的影响  

Effect of different inhaled oxygen concentrations in mechanical ventilation on normal pulmonary arterial blood oxygen pressure and inflammatory mediators

作　　者：常俊晓[1] 邢群智[1] 李毓[1] 韩学昌[1] 周民涛 董旭[1] 吴悠 CHANG Junxiao;XING Qunzhi;LI Yu;HAN Xuechang;ZHOU Mintao;DONG Xu;WU You(Department of Anesthesiology, College of Clinical Medicine ＆ First Affiliated Hospital, Henan University of Science and Technology, Luoyang Henan 471003, China)

机构地区：[1]河南科技大学临床医学院河南科技大学第一附属医院麻醉科,河南洛阳471003

出　　处：《临床与病理杂志》2018年第3期530-537,共8页Journal of Clinical and Pathological Research

摘　　要：目的:观察围术期患者机械通气过程中吸入不同氧浓度的变化,探讨其对肺功能正常患者血氧分压及炎症介质的影响。方法:将择期行胃肠道肿瘤根治术的患者120例随机分为4组:A组(35%FiO_2)、B组(50%FiO_2)、C组(75%FiO_2)和D组(100%FiO_2),每组30例。选取麻醉诱导前(T0)、气管插管后20 min(T_1)、气管插管后6 0 min(T_2)、手术结束时(T_3)及拔管后1 0 min(T_4)这5个时间点测量患者血清中SOD,TNF-α,IL-6及IL-10的水平及抽取动脉血行血气分析。结果:在PaO_2水平上,与A组相比,C,D组在T1~3时间点,B组T2~3时间点,PaO_2水平均显著上升,差异有统计学意义(P<0.01);在T4时间点,B,C,D组PaO_2水平呈下降趋势,差异有统计学意义(P<0.01)。在TNF-α,IL-6及IL-10水平上,与A组相比,B组在T4时间点,C组T3~4时间点,D组在T2~4时间点TNF-α,IL-6及IL-10水平显著升高,SOD水平显著下降,差异有统计学意义(P<0.05)。结论:机械通气过程中吸入35%氧浓度对肺功能正常的胃肠道肿瘤患者的动脉血氧分压及炎症介质的影响较小,可能是较合适的氧浓度。Objective： To evaluate the influence of mechanical ventilation during perioperative period on normal pulmonary arterial blood oxygen pressure and inflammatory mediators by inhalation of different oxygen concentrations. Methods： A total of 120 patients, who underwent elective gastrointestinal tumor radical resections, were randomly assigned to four groups, including Group A with an inhalation of 35% FiO2, Group B with an inhalation of 50% FiO2, Group C with an inhalation of 75% FiO2, and Group D with an inhalation of 100% FiO2（30 patients in each group）. Blood samples were obtained from each patient before induction of anesthesia（T0）, 20 min after tracheal intubation（T1）, 60 min after tracheal intubation（T2）, at the end of the operation（T3） and 10 min after extubation（T4） to measure serum levels of SOD, TNF-α, IL-6 and IL-10. Moreover, blood gas analysis was preformed to measure PaO2 at the same time. Results： At PaO2 level, PaO2 levels of Group C and D were significantly higher than Group A at time points of T（1–3）（P〈0.01）, while PaO2 level of Group B was significantly higher than that of Group A at time points of T（2–3）（P〈0.01）. PaO2 levels of Group B, C and D were significantly lower than that of group A at time point of T4（P〈0.01）. Moreover, at TNF-α, IL-6, IL-10 and SOD level, the serum levels of TNF-α, IL-6 and IL-10 in Group B were significantly higher than Group A, while the SOD level of Group B was significantly lower than Group A at time point of T4（P〈0.05）. The serum levels of TNF-α, IL-6 as well as IL-10 in Group C were significantly higher than Group A, while the SOD level of Group C was significantly lower than Group A at time points of T（2–3）（P〈0.01）. The serum levels of TNF-α, IL-6 and IL-10 of Group D were significantly higher than Group A, while the SOD level of Group D was significantly lower than that of Group A at time point of T（2–4）（P〈0.05）. Conclusion： The fraction of inspired oxygen at 35% had

关 键 词：吸入氧浓度 机械通气 炎症介质 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]