单腔气管插管通气产生的CO_(2)人工气胸允许性高碳酸血症对食管癌术后凝血纤溶及肺功能的影响  

Effect of permissive hypercapnia of CO_(2)artificial pneumothorax induced by single cavity tracheal intubation on coagulation,fibrinolysis,and lung function in esophageal cancer surgery

作　　者：程远建 易超 李瑞 CHENG Yuanjian;YI Chao;LI Rui(Department of Cardiothoracic Surgery,Panzhihua Central Hospital,Sichuan Province,Panzhihua 617067,China)

机构地区：[1]四川省攀枝花市中心医院心胸外科,四川攀枝花617067

出　　处：《中国医药导报》2023年第5期94-97,共4页China Medical Herald

基　　金：四川省卫生健康委员会科研项目(19PJ224)。

摘　　要：目的研究单腔气管插管通气产生的CO_(2)人工气胸允许性高碳酸血症对食管癌术后凝血纤溶及肺功能的影响。方法纳入2020年1月至2022年1月四川省攀枝花市中心医院收治的108例拟行胸腹腔镜手术治疗的食管癌患者为研究对象,按照随机数表法将其分为观察组和对照组,各54例。观察组术中经口插入单腔气管导管,对照组术中经口插入左双腔支气管导管。分析两组术前(T_(0))、肺通气开始60 min(T_(1))、肺通气停止30 min(T_(2))、术后1 d(T_(3))的凝血纤溶指标[凝血反应时间(R)、血凝块形成速率(K)、纤溶酶原激活物抑制物-1(PAI-1)、组织型纤溶酶原激活物(t-PA)]。记录并比较两组各时点的气道峰压及动态肺顺应性。结果观察组T_(1)、T_(2)的R、K值均高于T_(0),T_(2)的K值低于T_(1),T_(3)的R、K值均低于T_(1)、T_(2),且观察组T_(1)、T_(2)的R、K值均高于同期对照组(P<0.05)。观察组T_(3)的PAI-1及T_(1)的t-PA水平均低于同期对照组(P<0.05)。两组T_(1)、T_(2)、T_(3)的气道峰压均高于T_(0),T_(2)、T_(3)均低于T_(1),T_(3)低于T_(2)(P<0.05)。两组T_(1)、T_(2)、T_(3)的动态肺顺应性均低于T_(0),T_(2)、T_(3)均高于T_(1),T_(3)高于T_(2)(P<0.05)。观察组T_(1)、T_(2)、T_(3)的气道峰压均低于同期对照组,动态肺顺应性均高于同期对照组(P<0.05)。结论CO_(2)人工气胸允许性高碳酸血症对食管癌术后肺功能具有保护作用,可减少肺部感染发生,但对患者凝血纤溶功能产生一定影响,应注意防范围手术期出血。Objective To study the effect of permissive hypercapnia of CO_(2)artificial pneumothorax induced by single cavity tracheal intubation on coagulation,fibrinolysis,and lung function in esophageal cancer surgery.Methods A total of 108 patients with esophageal cancer expected to undergo laparoscopic thoracic surgery in Panzhihua Central Hospital of Sichuan Province from January 2020 to January 2022 were included as research objects,and they were divided into observation group and control group according to random number table method,with 54 patients in each group.In the observation group,the single lumen tracheal catheter was inserted orally,while in the control group,the left double-lumen bronchial catheter was inserted orally.The coagulation fibrinolytic indexes(coagulation response time[R],blood clot formation rate[K],plasminogen activator inhibitor-1[PAI-1],tissue plasminogen activator[t-PA])of the two groups were analyzed before surgery(T_(0)),60 min at the start of lung ventilation(T_(1)),30 min at the end of lung ventilation(T_(2)),and one day after surgery(T_(3)).Peak airway pressure and dynamic lung compliance were recorded,and compared between the two groups at each time point.Results In the observation group,R and K values at T_(1) and T_(2) were higher than those at T_(0),K value at T_(2) was lower than that at T_(1),and R and K values at T_(3) were lower than those at T_(1) and T_(2),R and K values at T_(1) and T_(2) in the observation group were higher than those in the control group at the same time point(P<0.05).The levels of PAI-1 at T_(3) and t-PA at T_(1) in observation group were lower than those in control group at the same time point(P<0.05).The peak airway pressures of two groups at T_(1),T_(2),and T_(3) were higher than those at T_(0),T_(2) and T_(3) were lower than T_(1),and T_(3) was lower than T_(2)(P<0.05).The dynamic lung compliance at T_(1),T_(2),and T_(3) was lower than that at T_(0),T_(2) and T_(3) were higher than T_(1),and T_(3) was higher than T_(2)(P<0.05).The peak airway pressures

关 键 词：气胸 食管癌 CO_(2) 肺功能 允许性高碳酸血症 

分 类 号：R735.1[医药卫生—肿瘤]