保护性通气策略对单肺通气患儿局部脑氧饱和度和S100β蛋白的影响

Effect of lung protective ventilation strategy on cerebral oxygenation and S100βin children undergoing one-lung ventilation

目的评价保护性通气策略对单肺通气(OLV)患儿局部脑氧饱和度(rScO_(2))和S100β的影响。方法选择2018年2月至2020年3月择期行胸科手术OLV患儿70例,男47例,女23例,年龄2个月至11岁,ASAⅡ或Ⅲ级。采用随机数字表法将患儿分为两组:常规通气组(CV组)和保护性通气组(PV组),每组35例。CV组双肺通气和OLV期间V T均为10 ml/kg;PV组双肺通气和OLV期间V T均为7 ml/kg,PEEP 5 cmH_(2)O。两组均在麻醉诱导后纤维支气管镜明视下插入支气管封堵器。记录OLV前(T_(1))、OLV 30 min(T_(2))、OLV结束后10 min(T 3)的MAP、Ppeak、rScO_(2)、PaO_(2)和血浆S100β蛋白浓度。结果与T_(1)时比较,T_(2)时两组MAP、PaO_(2)、rScO_(2)均明显降低,Ppeak明显升高(P<0.05)。T_(2)时PV组rScO_(2)明显高于CV组(P<0.05)。与T_(1)时比较,T_(2)和T 3时两组患儿S100β蛋白浓度明显升高,且PV组明显低于CV组(P<0.05)。结论保护性通气策略可通过降低S100β蛋白浓度改善OLV期间的脑氧合,具有一定的脑保护作用。

Objective To evaluate the effect of lung protective ventilation strategy on cerebral oxygenation and S100βin children undergoing one-lung ventilation(OLV).Methods Seventy children scheduled for one lung ventilation from February 2018 to MarcH_(2)020,aged 2 month to 11 years,ASA physical statusⅡorⅢwere randomly divided into two groups:conventional ventilation group(group CV)and protective ventilation group(group PV),35 children in each group.After induction,endobronchial blocker was inserted into trouble side under bronchoscopy.The Foresight electrode probe was used to continuously monitor oxygen saturation(rScO_(2)).Arterial blood gas analysis and S100βprotein detection in venous blood sampling was performed before OLV(T_(1)),30 minutes after OLV(T_(2))and 10 minutes after double lung ventilation(T 3).Results Compared with T_(1),rScO_(2),MAP and PaO_(2)decreased,Ppeak increased in both groups at T_(2)(P<0.05).rSCO_(2)in group PV was significantly higher than that in group CV at T_(2)(P<0.05).Compared with T_(1),the concentration of S100βprotein at T_(2)and T 3 increased significantly,while the amount of increase in group PV was less than that in group CV(P<0.05).Conclusion Protective ventilation strategy can improve brain oxygenation during OLV by inhibiting protenin relase and has a certain brain protection effect.