术中机械通气对Ⅱ型糖尿病患者肺换气功能的影响

Effect of intraoperative mechanical ventilation on alveolar gas exchange in patients with type 2 diabetes mellitus

目的探讨术中机械通气对Ⅱ型糖尿病患者肺换气功能的影响。方法择期全麻下行全胃切除术的Ⅱ型糖尿病患者30例和非糖尿患者15例，ASA分级Ⅰ或Ⅱ级，年龄46—64岁，体重47～78kg，非糖尿病患者为对照组（A组，n=15），30例糖尿病患者按照术前糖化血红蛋白（HbAIC）水平分为2组（n=15）：B组（HbAIC与Hb比值6．6％～10．4％）和c组（HbAlC与Hb比值〉10．4％）。麻醉诱导后气管插管，行机械通气，V，8ml／kg，RR12～14次／min，吸呼比1：2，吸入纯氧，维持PETc0230～35minHg。分别于麻醉前（R）、机械通气30rain（T1）、60min（T2）、90min（T3）、120min（T4）时采集桡动脉血样，进行血气分析，计算肺泡-动脉血氧分压差（PA-aDO2）；同时测定血浆SOD、MDA、TNF-α、IL-6及IL-10的水平。结果与A组比较，B组和c组T1-4时Pλ-aDO2、血浆MDA、TNF—α、IL-6和IL-10的浓度升高，血浆SOD活性降低（P〈0．05）。与B组比较，C组，T1-4时PA-aDO2、血浆MDA、TNF—α、IL-6和IL-10的浓度升高，血浆SOD活性降低（P〈0．05）。结论术中机械通气可使Ⅱ型糖尿病患者肺换气功能下降，且与病情有关，其机制与机械通气诱发炎性反应有关。

Objective To evaluate the effect of intraoperative mechanical ventilation on alveolar gas exchange in patients with type 2 diabetes mellitus. Methods Thirty ASA I or II patients with type 2 diabetes mellitus aged 46-64 yr weighing 47-78 kg undergoing total gastreetomy under general anesthesia were divided into 2 groups according to preoperative glycolated hemoglobin level （HbAle） （n = 15 each）： group B HbAlc/Hb = 6.6%-10.4% and group C HbAlc/Hb 〉 10.4%. Another 15 non-diabetic patients with comparable demographic data were included in this study as control group （group A）. Radial artery and right internal jugular vein were cannulated. The patients were intubated after induction of anesthesia and mechanically ventilated （VT 8 ml/kg, RR 12- 14 bpm, I：E 1：2, FiO2 1.0） . PET CO2 was maintained at 30-35 mm Hg during operation. Blood samples were collected from artery before induction of anesthesia （T0, baseline） and at 30, 60, 90 and 120 min of mechanical ventilation （TI-4 ） for blood gas analysis and determination of plasma SOD activity and MDA, TNF-α, IL-6, IL-10 concentrations. PA-αDO2 was calculated. Results PA-aDO2 was significantly increased during mechanical ventilation at T1-4 as compared with the baseline at To in diabetic patients and were significantly higher than in non-diabetic pa- tients. The plasma SOD activity was significantly decreased at TI.4 as compared with the baseline at To in diabetic patients and was significantly lower than in non-diabetic patients. While the plasma MDA, TNF-a, IL-6 and IL-10 concentrations were significantly increased at T1_4 compared with the baseline at To in diabetic patients and were significantly higher than in non-diabetic patients. The Pa-aDO2, plasma MDA, TNF-α, IL-6 and IL-10 concentrations were significantly higher and plasma SOD activity lower in gorup C than in group B. Conclusion Intraoperative mechanical ventilation can decrease alveolar gas exchange by inducing inflammatory response in patients with type 2 diabetes mellitus. The changes are correlated with severity of diabetes.