容量控制单肺通气联合肺保护性通气对老年患者肺功能、认知功能、炎症因子的影响  

Effect of volume controlled one lung ventilation combined with lung protective ventilation on lung function,cognitive function and inflammatory factors in elderly patients

作　　者：葛俐娜[1] GE Li′na(Department of General Medicine,the Fourth Affiliated Hospital of Nanchang University,Jiangxi Province,Nanchang 330002,China)

机构地区：[1]南昌大学第四附属医院全科医学,江西南昌330002

出　　处：《中国当代医药》2022年第35期14-18,共5页China Modern Medicine

基　　金：江西省卫生计生委科技计划项目(20155375)。

摘　　要：目的探究容量控制单肺通气(OLV)联合肺保护性通气对老年患者肺功能、认知功能、炎症因子的影响。方法选取2020年7月至2022年7月在南昌大学第四附属医院进行择期全麻手术的96例老年患者作为研究对象,按照简单随机化法将其分为观察组与对照组,每组各48例。观察组患者予以容量控制OLV+肺保护性通气,对照组患者予以容量控制OLV。比较两组患者OLV前、OLV后60 min和手术后当天的肺功能指标[动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))]、呼吸力学指标[气道峰压(P_(peak))、平台压(P_(plat))、气道阻力(R_(aw))]、炎症因子水平[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、胶原纤维酸性蛋白(GFAP)]与手术前、术后7 d、术后1个月的认知功能[简易精神状态检查(MMSE)量表]。结果两组患者OLV后60 min的PaO_(2)水平低于OLV前,OLV后60 min的PaCO_(2)、P_(peak)、P_(plat)、R_(aw)水平高于OLV前,且术后当天的PaO_(2)水平高于OLV后60 min,PaO_(2)水平低于OLV前;术后当天的PaCO_(2)、P_(peak)、P_(plat)、R_(aw)水平低于OLV后60 min,差异有统计学意义(P<0.05)。观察组患者OLV后60 min的P_(peak)、P_(plat)、R_(aw)水平低于对照组,OLV后60 min、术后当天的PaO_(2)水平高于对照组,差异有统计学意义(P<0.05)。两组患者术后7 d的MMSE评分低于术前,术后1个月的MMSE评分高于术后7 d,差异有统计学意义(P<0.05);术后7 d、术后1个月,观察组患者的MMSE评分高于对照组,差异有统计学意义(P<0.05)。观察组患者术后认知功能障碍发生率为8.33%(4/48),低于对照组的22.92%(11/48),差异有统计学意义(χ^(2)=3.872,P=0.049)。两组患者OLV后60 min的IL-6、IL-8、CFAP水平高于OLV前,术后当天的IL-6、IL-8、GFAP水平高于OLV后60 min,差异有统计学意义(P<0.05);术后当天,观察组患者的IL-6、IL-8、GFAP水平低于对照组,差异有统计学意义(P<0.05)。结论容量控制OLV联合肺保护性通气应用于老Objective To investigate the effect of volume controlled one lung ventilation(OLV)combined with lung protective ventilation on lung function,cognitive function and inflammatory factors in elderly patients.Methods Ninety six elderly patients who underwent elective laparoscopic surgery under general anesthesia in the Fourth Affiliated Hospital of Nanchang University from July 2020 to July 2022 were selected as the study subjects.They were divided into the observation group and the control group according to the simple random method,with 48 patients in each group.The patients in the observation group were given volume control OLV+lung protective ventilation,and the patients in the control group were given volume control OLV.The lung function indexes(arterial partial pressure of oxygen[PaO_(2)],arterial partial pressure of carbon dioxide[PaCO_(2)]),respiratory mechanics indexes(peak airway pressure[P_(peak)],platform pressure[P_(plat)],airway resistance[R_(aw)]),levels of inflammatory factors(interleukin-6[IL-6],interleukin-8[IL-8],collagen fibrillary acidic protein[GFAP])before and at 60 min after OLV and the day after surgery,cognitive function(minimum mental state examination[MMSE])1 month after operation were compared between the two groups.Results The PaO_(2) level at 60 min after OLV of the two groups were lower than those before OLV,the PaCO_(2),P_(peak),P_(plat) and R_(aw) levels at 60 min after OLV were higher than before OLV,and the PaO_(2) level on the day after surgery was higher than 60 min after OLV,PaO_(2) level was lower than before OLV,the levels of PaCO_(2),P_(peak),P_(plat) and R_(aw) on the day after surgery were lower than those at 60 min after OLV,and the differences were statistically significant(P<0.05).The levels of P_(peak),P_(plat) and R_(aw) at 60 min after OLV in observation group were lower than those in control group,while the levels of PaO_(2) at 60 min after OLV and on the day after surgery were higher than those in control group,the differences were statistically significant(P<0.05).

关 键 词：肺保护性通气 单肺通气 肺功能 认知功能 炎症因子 

分 类 号：R735.1[医药卫生—肿瘤]