不同单肺通气模式对食管癌手术患者肺损伤的影响

Influence of different patterns of one lung ventilation on lung injury in patients with esophageal carcinoma operation

目的探讨不同单肺通气模式对食管癌手术患者炎性反应和动脉氧合的影响。方法选择食管中段癌患者60例,随机均分两组。A组为开胸后持续单肺通气+4 cmH2O呼吸末正压至关胸,B组为开胸后单肺通气间隔45 min膨双肺5 min。分别于单肺通气前(T1),单肺通气30(T2)、60(T3)、90 min(T4),单肺通气结束前(T5)、出室前(T6)、术后24 h(T7)记录患者MAP、HR、SpO2、PaO2,并采集颈内静脉血行IL-6、IL-8、IL-10水平检测。结果两组PaO2于T2开始下降,T5时降至最低,T3、T4、T5时A组低于B组(P均<0.05)。两组IL-6、IL-8、IL-10均在T3开始明显上升(P均<0.01),T6达高峰,术后24 h降低但仍高于T1水平。IL-6、IL-8于T3、T4、T5、T6时A组低于B组(P均<0.05),而IL-10于T3、T4、T5、T6、T7时A组高于B组(P均<0.05)。结论食管癌手术患者术中行间断性单肺通气虽然改善动脉氧合,但反复肺萎陷复张所导致的肺部炎症反应更严重。

Objective To study the effects of inflammatory reaction of lung injury with different one lung ventilation patterns and values of oxygenation on patients undergoing esophageal surgery. Methods Sixty patients with esophageal cancer were randomly divided into two groups, A and B with 30 cases each. Group A： continual one lung ventilation ＋ 4 cmI-I20 peep until the end of operation; Group B ： intermittent one lung ventilation each 45 min with two lung ventilation 5 rain. Blood gas analysis was determined. The levels of MAP, HR, SpO2 and PaO2 were recorded immediately before one lung ventilation （OLV） （T1 ） , 30 min（ T2 ）, 60 min（ T3 ）, 90 min（ T4 ） following OLV, the end of the OLV（ T5 ）, out of the operating room（T6 ）, and after operation 24 hours（ T7 ）. Collecting blood 5 mL from internal jugular vein, the levels of IL-6, IL-8, IL-10 were detected. Results PaO2 in both groups was decreased at T2 and reached the lowest level at T5 , which was higher than that of group A at T3 , T4, T5 （ all P 〈 0.05 ）. The levels of IL-6, IL-8 and IL-IO in both groups be- gan to rise at T3 （ all P 〈 0.01 ）, reached peak level at T6 , and decreased gradually until T7, which were still higher than those at TI （ all P 〈 0.05）. The levels of IL6 and IL8 were lower in group A than those in group B at T3, T4, T5 T6 （ all P 〈 0.05 ）. However, the level of IL-10 was higher in group A than that in group B at T3 , T4, T5 , T6, T7 （ all P 〈 0.05）. Conclusions Intermittent one lung ventilation has more serious inflammatory reaction of lung injury, though it increases values of oxygenation.