双肺通气对胸腔镜联合腹腔镜下食管癌根治术高血压老年患者的影响

The Effect of Two-lung Ventilation on Thoracoscopy Combined with Laparoscopic Radical Resection of Esophageal Cancer in Elderly Patients with Hypertension

目的观察双肺通气对胸腔镜联合腹腔镜下食管癌根治术高血压老年患者的影响。方法随机选择自2016年7月至2016年12月在我院因食管癌根治术的老年患者68例,所有患者均进行术前谈话,将患者随机分为观察组(单腔气管插管双肺通气组,n=37例)和对照组(双腔气管插管单肺通气组,n=31例)。全凭静脉诱导与维持麻醉。记录比较两组患者麻醉诱导前(T_0)、手术开始60 min(T_1)和手术结束后双肺通气30 min(T_2)的各项血流动力学指标:有创平均动脉压(MAP)、每搏量变异度(SVV)、心脏指数(CI)、心率(HR)、每搏输出量(SV)、外周动脉心排血量(CO)、中心静脉压(CVP)以及患者手术后的预后情况。记录两组患者T_0、T_1、T_2三个不同时间中心静脉血肿瘤坏死因子TNF-α、白细胞介素-8(IL-8)、IL-10的浓度。结果两组患者在麻醉诱导前的各项血流动力学指标均无显著差异,观察组在T_1,CI、CO、SV、MAP大于对照组,SVV、HR观察组小于对照组;观察组在T_2,MAP、HR小于对照组(P<0.05)。观察组在T_1、T_2,TNF-α、IL-8的浓度低于对照组;在T_1、T_2,IL-10高于对照组(P<0.05)。两组患者TNF-α、IL-8、IL-10在T_0无显著差异(P>0.05)。患者肺部感染、术后咽痛、声音嘶哑和住院天数,观察组均小于对照组(P<0.05)。结论双肺通气可维持老年高血压患者手术中血流动力学的稳定,并对患者的愈后产生良好的影响。

Objective To observe the effect of two-lung ventilation on thoracoscopy combined with laparoscopic radical resection of esophageal cancer in elderly patients with hypertension. Methods 68 elderly patients with esophageal radical surgery were randomly selected from our hospital during July 2016 and December 2016, and all patients would have the preoperative conversation. The patients were randomly divided into observation group （n=37 eases） and control group （single- lung ventilation group, n=31）. The hemodynamic parameters of the two groups were compared before the anesthesia induction （T0）, 60 minutes after the beginning of the operation （T1） and 30 minutes after two-lung ventilation at the end of the operation （T2）, that is, the mean arterial pressure （MAP） stroke volume variability （SVV）, cardiac index （CI）, peripheral arterial cardiac output （CO）, stroke volume （SV）, heart rate （HR）, central venous pressure （CVP）, and postoperative recovery of patients： Record the concentration of T0, T1,T2 in different time of venous blood TNF-α, IL-8, IL-10. Results There were no significant differences in hemodynamics before induction of anesthesia. The cardiac index （CI）, peripheral arterial cardiac output （CO） and stroke volume （SV） were significantly higher than those in the control group, while stroke volume variability （SVV）, heart rate （HR） in the observation group was smaller than those in the control group （P〈0.05）. 30 minutes after two.lung ventilation at the end of the operation, MAP and HR in the observation group were significantly lower than those in the control group （P〈0.05）. Observation group of concentration of IL-8,TNF-α in T1, T2 is smaller than the control group,IL-10 is contrary （P〈0.05）. The concentration of three compared with two groups in TO had no significant difference （P〉0.05）.The patients with hoarseness, atelectasis and pulmonary infection and hospitalization days in the observation group were smaller than those in the control group （P〈0.05）. Conclusion Two-lung ventilation can maintain hemodynamics stability in elderly patients, improve the general condition of patients, and have a positive effect on the prognosis of patients.