小潮气量机械通气期间肺开放策略对肺损伤标志物的影响  

The Effects of Open-Lung Strategy on Lung Injury Markers in Patients under General Anesthesia with Low-tidal-volume Ventilation

作　　者：李宏[1] 王薇 廖耀军 郑志楠[1] 张南荣[1] 靳三庆[1] LI Hong;WANG Wei;LIAO Yao-jun;ZHENG Zhi-nan;ZHANG Nan-rong;JIN San-qing(Department of Anesthesia,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院麻醉科,广东广州510655

出　　处：《中山大学学报（医学科学版）》2020年第2期281-287,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2017045)。

摘　　要：[目的]探索外科手术中小潮气量机械通气期间应用间断肺复张手法(RM)联合中等水平呼气末正压(PEEP)构成的肺开放策略(OLS)对血浆中肺损伤标志物晚期糖基化终产物可溶性受体(sRAGE)及Clara细胞蛋白(CC16)浓度的影响.[方法]本研究纳入行择期腹腔镜结直肠癌切除术的患者100例,随机(1:1)分为开放策略组(OLS)和非开放策略(NOLS)组.两组均使用小潮气量机械通气;OLS组机械通气期间间断给予RM并设置PEEP为6~8 cmH2O,NOLS组不予RM及PEEP.麻醉诱导前(T1)、术毕后即刻(T2)及术后第3天(T3)分别取血检测血浆sRAGE、CC16浓度.[结果]在T1、T2、T33个时间点,血浆sRAGE、CC16浓度组间均无统计学差异(P>0.05).所有患者中,T2、T3 sRAGE浓度高于T1,T3sRAGE浓度高于T2,T3 CC16浓度高于T1、T2,均有统计学差异(P<0.05).[结论]术中小潮气量机械通气期间,应用间断RM联合中等水平PEEP的肺开放策略不能改变术后三天内血浆肺损伤标志物sRAGE和CC16的水平.【Objective】To determine the effects of an open-lung strategy(OLS)comprising moderate positive endexpiratory pressure(PEEP)and intermittent recruitment manoeuvres(RMs)on plasma levels of lung epithelial injury markers[i.e.soluble receptor for advanced glycation end products(sRAGE)and Clara cell protein(CC16)]during lowtidal-volume ventilation for surgery.【Methods】One hundred patients who were undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation were enrolled in this study.They were randomly assigned(1∶1)to the OLS group(using PEEP of 6~8 cmH2O and intermittent RM),or the NOLS group(without using PEEP and RM).Blood samples were taken before anesthesia induction(T1),immediately after surgery(T2)and the postoperative day 3(T3)to measure the plasma concentrations of sRAGE and CC16.【Results】Significant differences were not observed in the concentrations of sRAGE and CC16 at T1,T2 and T3 between the two groups(all P>0.05).For all the enrolled patients,the concentrations of sRAGE at T2 and T3 were higher than that at T1,the concentration of sRAGE at T3 was higher than that at T2,and the concentration of CC16 at T3 was higher than that at T1 and T2(all P<0.05).【Conclusions】In patients under general anesthesia with low-tidal-volume ventilation,the using of an OLS comprising medium PEEP and intermittent RMs can not alter plasma levels of lung epithelial injury markers(sRAGE and CC16)in three days after surgery.

关 键 词：肺开放策略 小潮气量机械通气 肺损伤标志物 晚期糖基化终产物可溶性受体 Clara细胞蛋白 

分 类 号：R614[医药卫生—麻醉学]