小潮气量机械通气对全麻患儿术中肺功能的影响

Influence of small tidal volume mechanical ventilation to lung function of children in general anesthesia

目的探讨小潮气量机械通气对全麻患儿术中肺功能的影响。方法选取48例行肠梗阻剖腹探查术的患儿,随机分为A、B两组,术中分别采用小潮气量和大潮气量机械通气,于插管前、插管后1 h和手术结束时分别采集外周血,用酶联免疫法检测患儿血浆中白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的浓度,同时抽取动脉血行血气分析。结果 A组其他时点同插管前比较,pH值、血氧饱和度差异均无统计学意义,B组各时点pH值比较,差异无统计学意义,两组患者在术中和术后均无低氧血症的情况出现;两组血浆中IL-6的水平在气管插管前差异无统计学意义,A组患者各时段IL-6水平差异无统计学意义,B组血浆中IL-6的水平在插管后1 h和手术结束时与插管前相比升高(P<0.05);两组患者血浆中TNF-血水平在插管前差异无统计学意义,B组插管后1 h和手术结束时与插管前相比升高(P<0.05)。结论大潮气量机械通气可引起患儿血浆IL-6和TNF-α水平升高,这可能是造成机械通气性肺损伤的原因之一,而小潮气量机械通气用于全麻患儿术中维持通气时,有助于肺功能的保护。

Objective To study the effect of low tidal volume mechanical ventilation on the lung protection of children in intraoperative anesthesia.Methods 48 cases of children with intestinal obstruction laparotomy were selected and randomly divided into A and B groups.The two groups were treated with low tidal volume and high tidal volume mechanical ventilation separately.Their peripheral blood were collected before intubation,after intubation 1 h and at the end of surgery, using enzyme-linked immunosorbent assay（ELISA） to test patients＇ plasma interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） concentration and to analyze arterial blood gas at the same time.Results The two groups in plasma IL-6 levels in tracheal intubation had no significant difference before.In group A there was no significant difference in IL-6 levels.Group B＇s plasma levels of IL-6 1 h after intubation and at the end of surgery was significantly higher（P 0.05） compared with before intubation.Two groups＇ plasma levels of TNF-a before intubation had no significant difference and group B＇s levels were significantly higher（P0.05） than those 1 h after intubation and at the end of surgery compared with before intubation.Conclusion Tidal volume ventilation can cause increase of plasma IL-6 and TNF-αlevel in children,which may be one of the reasons to result in mechanical ventilation-induced lung injury.The low tidal volume ventilation used for children in the maintenance of anesthesia in ventilation can contribute to the protection of lung function.