不同单肺通气时间对患者血流动力学、呼吸力学及支气管肺泡灌洗液中炎性因子的影响

Effect of single lung ventilation with different time on hemodynamics respiratory mechanics and inflammatory cytokines in bronchoalveolar lavage fluid

目的探索不同单肺通气时间对患者血流动力学、呼吸力学及支气管肺泡灌洗液中炎性因子水平的影响。方法根据单肺通气时间的不同将200名手术患者分成A、B、C组,分别测定各时间点的血流动力学、呼吸力学及支气管肺泡灌洗液中炎性因子的变化情况。结果 A、B、C三组间各时间点的心率、平均动脉压和中心静脉压之间的差异无统计学意义(P>0.05);但各组组内不同时间点的心率、平均动脉压和中心静脉压的差异显著(P<0.05)。在每分钟通气量上,C组显著高于A、B组;在呼气峰压上、B、C组各时间点均显著高于A组(P<0.05),B、C组T3时间点显著高于T2时间点(P<0.05)。在T3时间点上,A、B、C三组患者之间的TNF-α及IL-8值的差异显著(P<0.05)。无论是肺萎陷还是肺通气情况下,在T3时间点,A、B、C三组之间的TNF-α和IL-8值的差异有统计学意义(P<0.05);同组T3时间点的TNF-α及IL-8值均显著高于T2时间点(P<0.05)。结论不同单肺通气时间对患者的血流动力学及呼吸力学影响较小,而肺泡灌洗液中的TNF-α、IL-8浓度随着单肺通气时间延长而增加,萎陷肺要比通气肺更明显,较长时间的单肺通气可能会造成肺损伤。

Objective To study effect of single lung ventilation with different time on hemodynamics respiratory mechanics and inflammatory cytokines in bronchoalveolar lavage fluid. Methods 200 surgical patients were divided into the A,B,C groups according to their one-lung ventilation time,respectively. Their hemodynamics,respiratory mechanics and the change of inflammatory cytokines in bronchoalveolar lavage fluid were detected at different time points. Results There was no significant difference in heart rate,mean arterial pressure or central venous pressure at any time points among the three groups( P > 0. 05),but they showed significant difference in single group at different time points( P < 0. 05). For ventilatory capacity per minute,it was significantly higher in the group C than in the groups A and B. For expiratory peak pressure,it was significantly higher in the groups B and C than in the group A at each time points( P < 0. 05),and it was obviously higher at T3 than at T2 in the groups B and C( P <0. 05). At T3 time point,the levels of TNF-α and IL-8 showed significant differences among the three groups( P <0. 05). No matter under collapsed lung or lung ventilation at T3 time point,the levels of TNF-α and IL-8 showed statistical significance( P < 0. 05). The levels of TNF-α and IL-8 were significantly higher at T3 than T2( P < 0. 05).Conclusion Different one-lung ventilation time has little influence on hemodynamic and respiratory mechanics,but the levels of TNF-α and IL-8 in alveolar lavage fluid increase with prolonged one-lung ventilation time,and it was more obvious in atelectatic lung than ventilation lung. Long time of single lung ventilation may cause lung damage.