全麻不同潮气量机械通气对老年患者肺功能的影响

The Effect of Different Tidal Volume Ventilation on Pulmonary Function in Old Man

目的:探讨全麻不同潮气量机械通气对老年人肺功能的影响。方法:年龄大于60岁的老年直肠癌患者60例,随机分为三组,潮气量10ml/kg组(Ⅰ组),潮气量8ml/kg(Ⅱ组)和潮气量6ml/kg组(Ⅲ组),每组20例。机械通气后抽血测在麻醉后(T1)、麻醉后1h(T2)、麻醉后2h(T3)、麻醉后6h(T4)和麻醉后24h(T5)的TNF-а,IL-6,IL-10水平和RI值。结果:三组患者在麻醉后(T1)TNF-а,IL-6的水平无明显差异(P>0.05);Ⅲ组在T2～4的TNF-а,IL-6均低于Ⅰ、Ⅱ组,有显著性差异(P<0.05);IL-10水平在各组间无明显差异。三组患者RI麻醉麻醉后无明显差异(P>0.05),Ⅲ组在T3～5的RI均低于Ⅰ、Ⅱ组,有显著差异性(P<0.05)。RI与IL-6,TNF-α呈显著正相关,相关系数分别为r=0.79,0.78(P<0.05)。结论:老年患者在全身麻醉是,通过低潮气量的早期干预,减轻机械通气性肺损伤和维持致炎-抑炎因子状态平衡,对肺功能起保护作用。

Objective：To investigate the effects of different tidal volume ventilation on pulmonary function in old patients.Methods：Sixty patients,aged above 60,with rectum cancer were randomly divided into traditional tidal volume ventilation（group C） and low tidal volume ventilation（group L）.After ventilation,blood sample were taken from radial artery at the anesthesia induction（T1）,one hour after anesthesia induction（T2）,two hour after anesthesia induction（T3）,six hour after anesthesia induction（T4）,twenty-four hour after anesthesia induction（（T5）for determination of plasma TNF-а,IL-6,IL-10 concentration and Respiatory index（RI）=[P（A-a）DO2/PaO2]was calculated at the time.Results：The concentration of TNF-а,IL-6,was not significantly different at T1（P〈0.05）.But at T2-T5,the level of the TNF-а、IL-6 and Respiratory index in group Ⅲ has significant lower than the in group Ⅰ、Ⅱ（P〈0.05）,Respiratory index was positively correlated with the level of TNF-а、IL-6,histopathology score（r=0.79,0.78,P〈0.05）.There was no significant difference of IL-10 level in the two groups（P〈0.05）.Conclusion：Low tidal volume ventilation could alleviate ventilation induced lung injury and maintain balance of inflamm-antiflam cytokine in the old patients.