不同通气方式对胸腹腔镜食管癌根治术患者氧合和炎性因子的影响  

Effects of Different Modes of Lung Ventilation on Oxygenation and Inflammatory Factors in Patients Undergoing Radical Esophagectomy with Video-assisted Thoracoscopy

作　　者：李丽珍[1] 林芩[1] 王翔锋[1] 饶福东[1] 林树英[1] LI Lizhen;LIN Qin;WANG Xiangfeng;RAO Fudong;LIN Shuying(Department of Anesthesiology,People＇s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350004,Chin)

机构地区：[1]福建中医药大学附属人民医院麻醉科,福州350004

出　　处：《福建医科大学学报》2018年第2期120-124,共5页Journal of Fujian Medical University

基　　金：福建中医药大学附属人民医院2014年临床技术创新课题(CXZD201405)

摘　　要：目的观察单腔气管导管插管双肺通气配合二氧化碳(CO_2)充气和双腔气管导管插管单肺通气对胸腹腔镜食管癌根治术患者氧合和炎性因子的影响。方法选择择期行胸腹腔镜食管癌根治术的患者40例,ASA分级Ⅰ~Ⅱ级,年龄41~70岁,随机分成双腔气管导管插管单肺通气组(D组)和单腔气管导管插管双肺通气配合CO_2充气组(S组),每组20例。分别于麻醉诱导前(T0)、单肺通气(或进胸)后5min(T1)、单肺通气(或进胸)后30min(T2)、单肺通气(或进胸)后60min(T3)、拔管后5min(T4)、拔管后24h(T5)、拔管后72h(T6),观察:(1)氧合指标:T0~T5脉搏血氧饱和度(SpO_2)、动脉氧分压(PaO_2)及动脉CO_2分压(PaCO_2);(2)炎症因子水平:检测T0,T3~T6血清中超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)的浓度。结果 2组的SpO_2和PaO_2在T1时升高,T2及T3时下降,而PaCO_2在T1,T2及T3时均升高(P<0.05);S组的SpO_2,PaO_2和PaCO_2在T1,T2及T3时均高于D组(P<0.05)。2组的SOD从T3~T6均降低,在T4,T5及T6时S组均高于D组(P<0.05);与之相反,2组的MDA,TNF-α和IL-1β在T3~T6均升高,在T4,T5及T6时S组均低于D组(P<0.05)。结论单腔气管导管插管双肺通气配合CO_2充气可改善患者的氧合状况,减少炎性因子释放。Objective To observe effects of single lumen tracheal intubation combined with carbon dioxide insufflation or double lumen intubation on oxygenation and inflammatory factors for patients undergoing radical esophagectomy in video-assisted thoracoscopy. Methods Forty patients with esophageal carcinoma,aged 41-70 years old,ASA grade Ⅰ-Ⅱ,undergoing elective radical esophageal surgery with video-assisted thoracoscopy,were randomly divided into 2 groups（n=20 each）：double lumen endotracheal intubation with one-lunge ventilation（group D）and single lumen tracheal intubation in two-lunge ventilation with carbon dioxide insufflation intraoperatively（group S）. Observation points：（1）Oxygenation indexes including pulse oxygen saturation（SpO_2）,arterial oxygen partial pressure（PaO_2）and arterial carbon dioxide partial pressure（PaCO_2）were recorded at the following points of time：anesthetic induction（T0）,5 minutes after one-lung ventilation or entering thoracic cavity（T1）,30 minutes after one-lung ventilation or entering thoracic cavity（T2）,60 minutes after one-lung ventilation or entering thoracic cavity（T3）,5 minutes after tracheal extubation（T4）,and 24 minutes after tracheal extubation（T5）.（2）Levels of inflammatory factors including serum concentration of superoxide dismutase（SOD）,malondialdehyde（MDA）,tumor necrosis factor-α（TNF-α）and interleukin-1β（IL-1β）were also tested at T0,T3-T6[72 hours after tracheal extubation（T6）]. Results SpO_2 and PaO_2 in both groups rose at T1,and then dropped at the points of T2 and T3,while PaCO_2 in both groups rose at the points of T1,T2 and T3（P〈0.05）. SpO_2,PaO_2 and PaCO_2 in group S were significantly higher than those in group D at the points of T1,T2 and T3（P〈0.05）. Although concentration of SOD in both groups dropped from T3 to T6,SOD in group S was higher than those in group D at the points of T4,T5 and T6. On the contrary,concentration of MDA,TNF-αand IL-1βin both groups rose from

关 键 词：二氧化碳 肺换气 肺/生理学 氧 超氧化物歧化酶 丙二醛 肿瘤坏死因子α 白细胞介素类 食管肿瘤 

分 类 号：R322.3[医药卫生—人体解剖和组织胚胎学] R341[医药卫生—基础医学]