单肺通气时程对老年开胸手术患者肿瘤坏死因子-α、白细胞介素-8的影响

Effect of one-lung ventilation duration on tumor necrosis factor-α, interleukin-8 in elderly patients with open thoracic surgery

目的研究单肺通气时程对老年开胸手术患者肿瘤坏死因子-α（TNF—α）、白细胞介素-8（IL-8）的影响。方法选择建德市第一人民医院2011年1月～2013年12月收治的单肺通气开胸手术的老年患者153例,按照单肺通气时程将患者分为1组（〈1．5h）、2组（1．5-3h）、3组（〉3h），每组各51例。观察指标：各组患者在麻醉前（T1）、麻醉后（T2）以及手术结束前（T3）和术后1d（T4）的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）以及T2～T3时肺泡灌洗液中TNF-α和IL-8变化情况。结果①各组间同时间点HR、MAP、CVP比较，差异无统计学意义（P〉0．05）。同组内不同时点MAP、CVP差异有统计学意义（P〈0．05）。②在T3时点，1-3组萎陷肺及通气肺TNF-α、IL-8值均高于同组T2时点，差异有统计学意义（P〈0．05）。在T2时点，各组间比较差异无统计学意义（P〉0．05）；但在T3时点，2组萎陷肺TNF-α、T3组萎陷肺IL-8值均高于比同组通气肺，差异有统计学意义（P〈0．05）。结论不同单肺通气时程对老年患者术中、术后24h的血流动力学无显著影响，但肺泡灌洗液TNF-α和IL-8浓度随着单肺通气时间延长而增加，单肺通气超过3h最显著且萎陷侧肺比通气侧肺更加明显。

Objective To investigate the influence of one-lung ventilation on TNF-α, IL-8 in elderly patients with open thoracic surgery. Methods 153 patients with one-lung ventilation in thoracic operation in the First People＇s Hos- pital of Jiande City from January 2011 to December 2013 were selected and divided into lth group （〈1.5 h）, 2nd group （1.5-3 h）, 3rd group （〉3 h） according to the duration of the one-lung ventilation with 51 cases in each group. The HR, MAP, CVP, TNF-α and IL-8 were recorded and compared before anesthesia （T 1）, after anesthesia （T2）, before the end of surgery （T3） and 24 h after surgery （T4）. Results ①The differences of HR, MAP, CVP among each group were not statistically significant （P 〉 0.05）. The differences of MAP, CVP in the same group at different time were statistically significant （P 〈 0.05）. ②The TNF-α, IL-8 level of atelectatie lung and ventilation lung in lth-3rd group at the T3 time point were all higher than those at the T2 time point in the same group, the differences were statistically significant （P 〈 0.05）. The TNF-α level of ateleetatic lung in 2nd group, IL-8 level of atelectatic lung in lth-3rd group at the T3 time point were all higher than those of ventilation lung in the same group, the differences were statistically significant （P 〈 0.05）. Conclusion TNF-α and IL-8 can increase with the length of ventilation duration. The atelectatic lung has high- er TNF-α and IL-8 than the ventilation lung and it is more pronounced when the duration is longer than 3 h.