保护性通气模式联合右美托咪定对老年患者全身麻醉手术期间呼吸功能、炎症应激反应的影响

Effects of protective ventilation mode combined with dexmedetomidine on respiratory function and inflammatory stress response during general anesthesia in elderly patients

目的探讨保护性通气模式联合右美托咪定对老年患者全身麻醉手术期间呼吸功能、炎症应激反应的影响。方法回顾性选取2019年1月至2020年1月间在南京脑科医院进行肺癌根治术的老年患者106例,所有患者均接受右美托咪定麻醉。根据术中通气模式,将所有入组患者分为保护性通气模式组(n=55)、传统通气模式组(n=51)。对比两组患者的插管后双肺通气时(T0)、单肺通气后10 min(T1)、单肺通气后30 min(T2)、单肺通气后60 min(T3)、恢复双肺通气后10 min(T4)呼吸功能[动脉氧分压(Pa O_(2))、动脉二氧化碳分压(Pa CO_(2))、气道峰压(P_(max))]及静脉血炎症因子[白细胞介素(IL)-1、IL-6、肿瘤坏死因子α(TNF-α)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]水平的差异。结果T0时,两组患者各项指标的比较,差异无统计学意义(P>0.05)。T1、T2、T3时,保护性通气模式组患者的Pa O_(2)水平高于传统通气模式组患者,Pa CO_(2)、P_(max)水平低于传统通气模式组患者,差异均有统计学意义(P<0.05)。T4时,保护性通气模式组、传统通气模式组患者的Pa CO_(2)、P_(max)水平差异无统计学意义(P>0.05);保护性通气模式组患者的Pa O_(2)水平高于传统通气模式组患者,差异有统计学意义(P<0.05)。T1、T2、T3时,保护性通气模式组患者的IL-1、IL-6、TNF-α、MDA水平低于传统通气模式组患者,SOD水平高于传统通气模式组患者,差异均有统计学意义(P<0.05)。T4时,保护性通气模式组、传统通气模式组患者的IL-1、IL-6、TNF-α、MDA、SOD水平差异无统计学意义(P>0.05)。结论术中使用右美托咪定联合保护性通气模式可有效改善老年胸腔镜肺切除术患者的术中呼吸功能,减轻炎症应激反应。

Objective To investigate the effects of protective ventilation mode combined with dexmedetomidine on respiratory function and inflammatory stress response in elderly patients during general anesthesia.Methods A total of 106 elderly patients undergoing radical resection of lung cancer in Nanjing Brain Hospital from January 2019 to January 2020 were retrospectively analyzed,all patients were received dexmedetomidine anesthesia.All patients were divided into protective ventilation mode group(n=55)and traditional ventilation mode group(n=51)according to the intraoperative ventilation mode.Respiratory function[arterial partial pressure of oxygen(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),peak airway pressure(P_(max))],inflammatory factors[interleukin(IL)-1,interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α)],oxidative stress indices[malondialdehyde(MDA)and superoxide dismutase(SOD)]were compared between two groups after intubation at double lung ventilation(T0),10 min after one-lung ventilation(T1),30 min after one-lung ventilation(T2),60 min after one-lung ventilation(T3),10 min after restoration of double lung ventilation(T4).Results At T1,T2 and T3,the levels of PaO_(2) and P_(max) in protective ventilation mode group were higher than those in traditional ventilation mode group,the levels of PaCO_(2) and P_(max) were lower than those in traditional ventilation mode group,the differences were statistically significant(P<0.05).At T4,there were no significant difference in the levels of PaO_(2),PaCO_(2) and P_(max) between protective ventilation mode group and traditional ventilation mode group(P>0.05).The level of PaO_(2) in the protective ventilation mode group was higher than that in the traditional ventilation mode group,and the difference was statistically significant(P<0.05).At T1,T2 and T3,the levels of IL-1,IL-6,TNF-αand MDA in protective ventilation mode group were lower than those in traditional ventilation mode group,the level of SOD was higher than that in traditional ventilation mode group,the differences were statistically significant(P<0.05).At T4,there were no significant differences in IL-1,IL-6,TNF-α,MDA and SOD levels between protective ventilation mode group and traditional ventilation mode group(P>0.05).Conclusion Using of protective ventilation mode during surgery can effectively improve the intraoperative respiratory function and reduce the inflammatory stress response in elderly patients with thoracoscopic pneumonectomy.