快速预处理联合控制性涨肺对行单肺通气手术患者的肺保护作用

Lung protection in patients with one-lung ventilation surgery after combinating rapid preconditioning and controlled reinflation

目的:观察单肺通气(one-lung ventilation,OLV)手术患者术中联合快速预处理和控制性涨肺能否达到叠加的肺保护作用。方法:择期胸科手术成年患者120例,数表法随机分A组、B组、A+B组、C组,各30例。以丙泊酚靶控输注、舒芬太尼和顺式阿曲库铵间断静注进行诱导并维持麻醉,插入双腔支气管导管(double-lumen bronchial tube,DLT)后行机械通气。A组为快速预处理组,开始铺巾时,钳夹DLT非通气侧Y型接头3次,使DLT气管腔与大气相通,每次OLV 1 min,恢复双肺通气(two-lung ventilation,TLV)1 min;B组为控制性涨肺组,在机械通气VT10 mL/kg,RR12次/min 5个循环后,再做手控涨肺;A+B组联合快速预处理和控制性涨肺;C组为对照组。记录术前、预处理前后、OLV 20 min后、涨肺前后、TLV 20 min后、拔管后30 min、术后6 h、术后第1天各时间点的血液动力学、氧合指数(oxygenation index,OI)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等指标。结果:A组和A+B组患者在OLV的OI高于C组;涨肺后,B组和A+B组的血液动力学指标更平稳;术后,A+B组OI最高,IL-6、TNF-α水平最低,且无发生肺部并发症(P<0.05或0.01)。结论:快速预处理和控制性涨肺的有机结合能达到更高效能的肺保护作用。

Objective:To observe whether patients with OLV surgery can achieve superimposed lung protection by combining rapid preconditioning and controlled reinflation during the perioperative period.Methods:120 adult patients undergoing elective thoracic surgery,randomly divided into group A,group B,group A+B,and group C,30 cases in each group.Anesthesia was induced and maintained with propofol target-controlled infusion,sufentanil and cis-atracurium were injected intermittently,then insert a DLT.To make a rapid preconditioning in group A.When the towel was started,the DLT non-ventilated side Y-joint was clamped three times,then made the DLT tracheal cavity was connected to the atmosphere to OLV for 1 min each time,and TLV was restored for 1 min each time.To make a controlled reinflation in group B.In group B,5 cycles of mechanical ventilation with a VT 10ml/kg and RR 12 bpm were performed before manual reinflation.In group A+B,taking both rapid preconditioning and controlled reinflation.Group C is the control group.The hemodynamic parameters,oxygenation index,IL-6,TNF-α and other indicators were recorded before surgery,before and after preconditioning,after OLV 20 min,before and after reinflation,after TLV 20 min,30 min after extubation,6 h after surgery,and one day after surgery.Results:Patients in group A and group A+B had higher OI during OLV than group C.Hemodynamic index of group B and group A+B were more stable after reinflation.After surgery,group A+B had the highest OI,the lowest IL-6 and TNF-α,and no pulmonary complications ( P <0.05 or P <0.01).Conclusion:The combination of rapid preconditioning and controlled reinflation can achieve a higher potency of lung protection.