肺保护通气策略在肺结核纤维板剥脱术患者单肺通气期间的肺保护作用

Lung protection of lung protection ventilation strategy during one lung ventilation in patients with tuberculous pleural fibrous plate stripping

目的研究肺保护通气策略在肺结核纤维板剥脱术患者单肺通气(One lung ventilation,OLV)期间的临床应用价值。方法选取2017年1月~2018年6月择期全麻下行肺结核纤维板剥脱术的患者58例,年龄18~75岁,体重指数17~25 kg/m2,ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为两组(n=29):容量控制通气(Volume control ventilation,VCV)组和保护性通气(Protective ventilation,PV)组。于双肺通气改变体位后15 min(T0)、单肺通气30 min(T1)和恢复双肺通气后15 min(T2)时,采集桡动脉血液进行血气分析,检测pH值、血氧分压(PaO2)和血二氧化碳分压(PaCO2)等指标;同时记录呼吸力学指标包括气道峰压(Peak pressure,Ppeak)、气道阻力(Airway resistance,Raw)和肺动态顺应性(Dynamic compliance,Cdyn)。分别于麻醉诱导前及术毕采集桡动脉血样,采用ELISA法测血浆NE、TNF-α、IL-6和IL-8的浓度。结果与VCV组相比,PV组Ppeak、Raw降低,Cdyn增加;术毕血浆NE、TNF-α、IL-6和IL-8浓度降低(P<0.05)。结论保护性肺通气可减轻肺结核纤维板剥脱术患者单肺通气期间肺损伤,减轻炎性反应,值得在临床中推广使用。

Objective To study the clinical application value of lung protection ventilation strategy during one lung ventilation(OLV)in patients with tuberculosis pleural fibrous plate stripping.Methods A total of 58 patients with tuberculosis pleural fibrous plate stripping under elective general anesthesia from January 2017 to June 2018,aged 18-75 years,body mass index 17-25 kg/m2,ASA gradeⅡorⅢ,were randomly divided into two groups(n=29)including volume control ventilation(VCV group)and protective ventilation group(Protective ventilation,PV group).At 15 min(T0)after two-lung ventilation position changes,30 min(T1)after one-lung ventilation,and 15 min(T2)after returning to two-lung ventilation,blood was collected from the radial artery for blood gas analysis.The pH and blood oxygen partial pressure(PaO2)and blood carbon dioxide partial pressure(PaCO2)and other indicators were detected.The respiratory mechanics indexes including Peak pressure(Ppeak pressure,Ppeak),airway resistance(Raw)and lung dynamic compliance(Cdyn)were recorded simultaneously.Radial arterial blood samples were collected before and after anesthesia induction,and plasma NE,TNF-α,IL-6 and IL-8 concentrations were measured by ELISA.Results Compared with that of the VCV group,Ppeak and Raw was lower,Cdyn increased in the PV group,and plasma NE,TNF-α,IL-6 and IL-8 levels in the PV group decreased after surgery(P<0.05).Conclusion Protective lung ventilation can alleviate lung injury and reduce inflammatory response during one lung ventilation in patients with tuberculous pleural fibrous plate stripping,reduce inflammation.Therefore,it is worthy of popularization in clinical practice.