低潮气量通气策略在开颅手术患者中的应用

Application of low tidal volume ventilation strategy in patients undergoing craniotomy

目的观察低潮气量通气应用于开颅手术患者时的通气效果及其对围术期炎症反应的影响。方法60例择期行开颅手术、预计手术时间超过3小时的患者,ASAI-II级,麻醉诱导气管插管后,采用数字表法随机分为低潮气量组(L组)和高潮气量组(H组)。L组潮气量6ml·kg-1,PEEP为10cm H2O;H组潮气量12ml·kg-1,PEEP为0cm H2O。分别于麻醉诱导后5min(T1),通气1h(T2),通气3h(T3),术毕(T4),拔管后(T5)抽取动脉血气进行血气分析,记录各时间点PaO2,并计算氧合指数(OI=PaO2/FiO2),在术前及术毕抽取静脉血测定血浆白细胞介素IL-6、IL-8、肿瘤坏死因子-α、MDA、SOD浓度。结果 L组与H组PaO2、氧合指数OI值各时间点比较无统计学差异(P<0.05)。术前与术毕血浆IL-6、TNF-α、SOD浓度两组比较无统计学差异;IL-8、MDA在L组术毕浓度与术前相比明显下降,差异有统计学意义(P<0.05),两组患者术毕IL-8和MDA浓度相比差异有统计学意义(P<0.05)。结论低潮气量通气策略对肺功能正常择期行开颅手术患者的氧合无明显影响,但可降低术后部分炎症因子的释放,减少脂质过氧化物的生成。

Objective We observed influence of oxygenation and perioperative inflammation of mechanical ventilation with low tidal volume in patients undergoing craniotomy.Methods 60 cases of patients undergoing craniotomy,ASAI-II,operation time more than three hours,were randomly divided into L group and H group after induced with rapid intravenous anesthesia and tube intubation.In L group,patients received low tidal with tidal volume of 6 ml·kg-1 with PEEP 10 cm H2O.In H group,patients received high ventilation with tidal volume of 12ml·kg-1without PEEP.5minutes after anesthesia（T1）,1h（T2）after mechanical ventilation,3h（T3）after mechanical ventilation,end of operation（T4）,after extubation（T5）,the arterial blood gas were analyzed,PaO2 were recorded and index of oxygenation（OI=PaO2/FiO2）were calculated.In the preoperation and postoperation,the venous blood samples were taken for detecting IL-6、IL-8、TNF-α、MDA、SOD.Results OI and PaO2 at T1-T5 were not statistically different in Group L,compared with those in H group（P〉0.05）.In the preoperation and postoperation,concentrations of IL-6、TNF-α、SOD were not statistically different in both groups.In L group,concentrations of IL-8、MDA in the postoperation significantly decreased compared with preoperation（P〈0.05）.The concentrations of IL-8、MDA were statistically different between the two groups in the postoperation（P〈0.05）.Conclusion Mechanical ventilation with low tidal volume has no significant effect on the oxygenation in patients with normal lung function undergoing craniotomy,but reduces the release of part of postoperative inflammatory cytokines and the generation of lipid peroxides.