自主呼吸麻醉肺减容术对肺气肿患者气道炎症的影响

Effect of spontaneous breathing and anesthesia on pulmonary airway inflammation in patients with emphysema

目的探讨自主呼吸麻醉肺减容术对肺气肿患者气道炎症的影响。方法选择本院2013年2月至2016年2月行肺减容术治疗的肺气肿患者54例,随机数字表分为对照组和观察组各27例,对照组采用常规的机械通气进行麻醉,观察组采用自主呼吸麻醉方式进行麻醉。观察两组患者的拔管时间及苏醒时间,并观察两组患者治疗前及治疗后的动脉血气情况、炎症指标水平及肺功能情况,同时观察两组患者的不良反应发生情况。结果观察组患者的拔管时间及苏醒时间均短于对照组患者,组间比较存在明显差异(P<0.05)。治疗前,两组患者的PaO_2及PaCO_2指标水平比较无显著性差异(P>0.05)。比较分析两组患者治疗后Pa O2及Pa CO2指标水平,治疗后,对照组患者的Pa O2明显低于观察组,PaCO_2值明显低于高于观察组,组间存在明显差异(P<0.05)。治疗前,两组患者炎症指标水平比较无明显差异(P>0.05)。治疗后,两组患者炎症指标水平与治疗前相比明显降低(P<0.05),且对照组患者IL-6、IL-8明显高于观察组(P<0.05),但两组治疗后TNF-α无显著差异(P>0.05)。治疗前,两组患者的FEV1、FVC、FEV1/FVC指标水平比较无显著性差异(P>0.05)。治疗后,两组患者的FEV1、FVC、FEV1/FVC指标水平较治疗前显著升高(P<0.05),而观察组的FEV1、FVC、FEV1/FVC指标水平显著高于对照组(P<0.05)。两组患者不良反应发生率无明显差异(P>0.05)。结论采用自主呼吸麻醉对行肺减容术肺气肿患者进行麻醉,拔管时间短患者易于清醒,可以有效改善患者的血气情况、炎症反应及肺功能,减少患者不良反应的发生,与采用常规的机械通气麻醉方式相比更适合行肺减容术肺气肿患者。

Objective To explore the effect of spontaneous breathing and anesthesia on pulmonary airway inflammation in patients with emphysema. Methods All of 54 emphysema patients with lung volume reduction surgery from February 2013 to February 2016 were analyzed,it was randomly divided into control group and observation group with 27 cases in each group,the control group using conventional ventilation anesthesia,observation group with spontaneous breathing anesthesia for anesthesia. It was observed that extubation time and recovery time,and the arterial blood gas,inflammation index level and pulmonary function of two groups before and after treatment,and the adverse reactions of the two groups were detected. Results The extubation time and recovery time of the observation group were shorter than those of the control group. There were significant differences between the two groups( P <0.05). Before treatment,the PaO_2 and PaCO_2 levels of the two groups had no significant difference( P>0.05). After treatment,the PaO_2 and PaCO_2 levels of the two groups were compared. The PaO_2 of the control group was significantly lower than that of the observation group.The PaCO_2 value was significantly lower than that of the observation group( P<0.05). Before treatment,there was no significant difference in the level of inflammatory markers between the two groups( P > 0. 05). After treatment,the levels of inflammatory markers in the two groups were significantly lower than those before treatment( P<0.05),and IL-6,IL-8 in the control group were significantly higher than those in the observation group( P<0. 05). but there was no significant different of TNF-α in two groups( P > 0. 05). There was nosignificant difference in FEV1,FVC,FEV1/FVC levels between the two groups before treatment( P > 0. 05).After treatment,the FEV1,FVC,FEV1/FVC levels of the two groups were significantly higher than those of the control group( P<0.05),and FEV1,FVC,FEV1/FVC of the observation group were significantly higher than those of the control group). There was no significant difference between the two groups in the incidence of adverse reactions( P > 0. 05). Conclusions Anesthesia is performed in patients with pulmonary emphysema who underwent lung volume reduction with spontaneous breathing anesthesia,The patients with short extubation time can be easily awake and can improve the blood gas condition,inflammatory reaction and pulmonary function of patients,and reduce the occurrence of adverse reactions. It is more suitable for lung volume reduction emphysema patients compared with conventional mechanical ventilation anesthesia.