保护性单肺通气策略在食管癌全麻手术中的应用  

Application of protective one-lung ventilation strategy in general anesthesia for esophageal cancer

作　　者：于霖[1] 庾燕君[1] 韩琪[1] 廖永强[1] YU Lin;YU Yan-jun;HAN Qi;LIAO Yong-qiang(Department of Anesthesiology,Dongguan People's Hospital,Dongguan 523000,Guangdong,CHINA)

机构地区：[1]东莞市人民医院麻醉科,广东东莞523000

出　　处：《海南医学》2020年第13期1695-1698,共4页Hainan Medical Journal

基　　金：广东省东莞市一般项目(编号:201750715001288)。

摘　　要：目的探讨保护性单肺通气策略对食管癌全麻手术患者的肺功能及炎症指标的影响。方法选择2018年3月至2019年9月在东莞市人民医院行食管癌全麻手术患者100例为研究对象,按照随机数表法将患者分为观察组和对照组,每组50例。对照组给予传统通气方式,观察组给予保护性单肺通气策略。在术前和术后24 h比较两组患者的吸气平台压(PP)、气道峰压(PIP)、气道阻力(Raw)、白细胞介素-6(IL-6)、白细胞介素-8(interleukin-8,IL-8)、可溶性细胞间黏附分子(Sicam-1)、二氧化碳分压(PaCO2)、血氧分压(PaO2)、氢离子浓度指数(pH)水平和并发症发生情况。结果两组患者术前的肺功能水平比较差异无统计学意义(P>0.05);观察组和对照组患者术后24 h的PP[(17.76±2.55)mmHg vs(22.76±4.81)mmHg]、PIP[(23.15±4.68)mmHg vs(31.34±5.27)mmHg]和Raw[(17.36±2.83)mmHg vs(19.75±3.21)mmHg]水平比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);两组患者术前的炎症水平比较差异无统计学意义(P>0.05);观察组和对照组患者术后24 h的IL-6[(191.26±27.34)ng/L vs(258.15±29.41)ng/L]、IL-8[(21.56±2.73)ng/L vs(29.43±3.58)ng/L]、Sicam-1[(159.38±35.14)μg/L vs(178.56±41.42)μg/L]水平比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);两组患者术前的血气指标水平比较差异均无统计学意义(P>0.05);观察组和对照组患者术后24 h的PaO2[(75.08±10.12)mmHg vs(62.23±10.06)mmHg]、pH值[(7.38±0.16)vs(7.31±0.13)]比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);观察组患者术后24 h的PaCO2水平为(41.11±7.22)mmHg,明显低于对照组的(53.84±8.66)mmHg,差异有统计学意义(P<0.05);观察组患者术后的并发症总发生率为8.0%,明显低于对照组的25.0%,差异有统计学意义(P<0.05)。结论保护性单肺通气策略应用于食管癌全麻手术患者可有效改善患者肺功能及炎症水平,值得推广应用。Objective To explore the effect of protective one-lung ventilation strategy on lung function and inflammation index of patients undergoing general anesthesia for esophageal cancer.Methods From March 2018 to September 2019,100 patients with esophageal cancer undergoing general anesthesia in Dongguan People’s Hospital were selected as the study objects.According to random number table method,the patients were divided into the observation group and control group,with 50 patients in each group.The control group was given traditional ventilation,and the observation group was given protective one-lung ventilation strategy.The levels of inspiratory plateau pressure(PP),peak airway pressure(PIP),airway resistance(Raw),interleukin-6(IL-6),interleukin-8(IL-8),soluble intercellular adhesion molecule(sICAM-1),partial pressure of carbon dioxide(PaCO2),partial pressure of blood oxygen(PaO2),hydrogen ion concentration index(pH)and complications of the two groups were compared before and 24 hours after operation situation.Results There was no significant difference in preoperative pulmonary function between the two groups before operation(P>0.05);the levels of PP,PIP and Raw in the observation group were(17.76±2.55)mm Hg,(23.15±4.68)mmHg,(17.36±2.83)mmHg,respectively,which were significantly lower than corresponding(22.76±4.81)mmHg,(31.34±5.27)mmHg,(19.75±3.21)mm Hg in the control group(all P<0.05);there was no significant difference in inflammation levels between the two groups before operation(P>0.05);the levels of IL-6,IL-8,sICAM-124 hours after operation in the observation group were(191.26±27.34)ng/L,(21.56±2.73)ng/L,(159.38±35.14)μg/L,respectively,which were significantly lower than corresponding(258.15±29.41)ng/L,(29.43±3.58)ng/L,(178.56±41.42)μg/L in the control group(all P<0.05);there was no significant difference in blood gas index levels between the two groups before operation(P>0.05);the levels of PaO2 and pH in the observation group were(75.08±10.12)mmHg and 7.38±0.16,which were significantly highe

关 键 词：食管癌 全麻手术 保护性单肺通气策略 肺功能 炎症 效果 

分 类 号：R735.1[医药卫生—肿瘤]