保护性单肺通气在食管癌根治术中的应用

Application of protective one-lung ventilation on radical resection of esophageal cancer

目的探讨保护性单肺通气在食管癌根治术中的应用价值。方法将40例择期行食管癌根治术患者随机均分为对照组与观察组,对照组患者行传统方法单肺通气,潮气量为10 ml/kg,呼气末正压为0 cm H2O;观察组患者行保护性单肺通气,潮气量为8 ml/kg,呼气末正压为5 cm H2O。分别在单肺通气前(T1)、单肺通气开始后1 h(T2)、单肺通气开始后2 h(T3)及术后2 h(T4)监测心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、中心静脉压(CVP)的变化,分析动脉血气指标并计算出氧合指数(OI),检测外周血中炎症介质(IL-6、IL-8、IL-10)。结果两组OI均显著降低(P<0.05),对照组OI在T2、T3时明显低于观察组(P<0.05)。两组IL-6、IL-8的血清浓度T2时明显高于T1时(P<0.05),IL-10于T3、T4时明显高于T1时(P<0.05)。与对照组比较,观察组T3、T4时IL-6、IL-8血清浓度均较低(P<0.05),IL-10浓度明显较高(P<0.05)。结论保护性肺通气能够维持相对较好的OI,减轻了食管癌根治术肺的炎性反应。

Objective To investigate the effect of protective one-lung ventilation on raolcal resecuon of esophageal cancer.Methods Forty patients with esophageal cancer were randomly divided into control group and observation group with 20 cases in each.The control group was given traditional methods of one-lung ventilation,tidal volume was 10 ml/kg, PEEP was 0 cm HEO;the observation group was given protective one-lung ventilation,tidal volume was 8 ml/kg,PEEP was 5 cm H2O.The heart rate （HR）,mean arterial pressure （MAP）,pulse oximetry （SpO2）,central venous pressure （CVP） changes before one-lung ventilation （T1）,after the start of one-lung ventilation 1 h （T2）,after the start of one-lung venti- lation 2 h （T3） and after 2 h operation （T4） was monitored respectively,arterial blood gas was analyzed and calculated the index oxygenation index （OI）,pefipheral blood inflammatory mediators （IL-6,IL-8,IL -10） was detected.Results OI of two groups was significantly decreased （P〈0.05）,the control group at T2,T3 was significantly lower than that of the observation group （P〈0.05）.In two groups,IL-6,IL-8 at T2 was significantly higher than that at T1 （P〈0.05）,IL-10 at T3, T4 was higher than that at T1 （P〈0.05）.IL-6,IL-8 of the observation group at T3,T4 was lower than that of the control group （P〈0.05）,IL-10 was significantly higher than that of the control group （P 〈0.05）.Conclusion Protective one-lung ventilation can maintain relatively good OI,reduce esophageal resection of the lung inflammatory response.