全麻联合硬膜外麻对老年胸腔镜单肺通气患者的肺保护作用及机制

Protective effect and mechanism of general anesthesia combined with epidural anesthesia on elderly patients with thoracoscopic one-lung ventilation

目的探究全麻联合硬膜外麻对老年胸腔镜单肺通气患者的肺保护作用,并分析其作用机制。方法选择2019年4月至2021年4月收治的128例择期行胸腔镜手术单肺通气的老年患者作为研究对象,以术中麻醉方式采用全麻联合硬膜外麻的患者作为联合组,以采用全身麻醉的患者为全麻组,每组各64例。比较2组患者的一般资料、术中情况、术后并发症及术后恢复指标;比较2组患者术前30 min(T_(0))、单肺通气30 min(T_(1))、单肺通气60 min(T_(2))、单肺通气结束即刻(T_(3))和手术结束即刻(T_(4))的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))、pH、血红蛋白(Hb)、血清丙二醛(MDA)、超氧化物歧化酶(SOD)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血红素加氧酶-1(HO-1)及非通气侧支气管肺泡灌洗液(BALF)中HO-1水平。结果2组患者的一般资料,术中情况,术后并发症,T_(0)、T_(4)时的HR、MAP,T_(0)、T_(1)、T_(2)时的血清MDA、SOD、IL-6、TNF-α、HO-1、BALF中HO-1水平及围术期SpO_(2)、pH、Hb差异无统计学意义(P>0.05)。T_(1)、T_(2)、T_(3)时2组患者的HR、MAP明显低于同组T_(0)时,且联合组明显高于全麻组(P<0.05);T_(3)、T_(4)时2组患者的血清SOD、HO-1、BALF中HO-1水平明显低于同组T_(0)时,MDA、IL-6、TNF-α明显高于同组T_(0)时,且联合组上述各指标变化幅度明显小于全麻组(P<0.05);联合组术后拔管时间、苏醒时间明显短于全麻组(P<0.05)。结论全麻联合硬膜外麻能够维持胸腔镜单肺通气老年患者的血流动力学相对稳定,降低MDA和炎性细胞因子水平,提高SOD和HO-1表达水平,发挥肺保护作用。

AIM To explore the protective effect of general anesthesia combined with epidural anesthesia on elderly patients with thoracoscopic one-lung ventilation,and analyze its mechanism of action.METHODS A total of128 elderly patients who underwent one-lung ventilation during thoracoscopic surgery from April 2019 to April 2021were selected as the study objects,and the patients with intraoperative anesthesia combined with epidural anesthesia were selected as the combined group,the patients under general anesthesia were taken as the general anesthesia group,with 64patients in each group.The general information,intraoperative conditions,postoperative complications and postoperative recovery indicators of 2 groups of patients were compared.The 2 groups were compared with 30 min before surgery(T_(0)),one-lung ventilation 30 min(T_(1)),and one-lung ventilation 60 min(T_(2)),immediately after completion of single lung ventilation(T_(3))and immediately after completion of surgery(T_(4)),including heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),p H,hemoglobin(Hb),serum malondialdehyde(MDA),superoxide dismutase(SOD),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),heme oxygenase-1(HO-1)and non-ventilated bronchoalveolar HO-1 level in lavage fluid(BALF).RESULTS Compared the general information,intraoperative conditions,postoperative complications,HR and MAP at T_(0)and T_(4),MDA,SOD,IL-6,TNF-α,HO-1,BALF in serum at T_(0),T_(1)and T_(2),the level of HO-1 and SpO_(2),p H and Hb in the perioperative period,no significant difference was found(P>0.05).The HR and MAP of the 2 groups of patients at T_(1),T_(2)and T_(3)were significantly lower than that at T_(0),and the combined group was significantly higher than that of the general anesthesia group(P<0.05).The serum SOD,HO-1 and HO-1 in BALF of the 2 groups of patients at T_(3)and T_(4)were significantly lower than T_(0).MDA,IL-6,and TNF-αwere significantly higher than that at T_(0),and the changes of the indexes in the combined group were significantly smaller than those in the general anesthesia group(P<0.05).The extubation time and recovery time in the combined group were significantly shorter than those in the general anesthesia group(P<0.05).CONCLUSION General anesthesia combined with epidural anesthesia can maintain the relative stability of hemodynamics in elderly patients with thoracoscopic one-lung ventilation,reduce the levels of MDA and inflammatory cytokines,increase the expression levels of SOD and HO-1,and play a lung protective role.