单肺通气保护策略在肺叶切除术中的应用

Application of One-lung Ventilation Protection Strategy in Pulmonary Lobectomy

目的:探究单肺通气(OLV)保护策略在肺叶切除术中的应用效果。方法:选取福建医科大学附属泉州第一医院2019年4月-2020年10月收治的114例行肺叶切除术的患者作为研究对象。随机将其分为A组(57例)和B组(57例)。两组均进行肺叶切除术,B组术中采用常规单肺通气,A组术中实施单肺通气保护策略。比较两组术前、术后3 d肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、一秒率(FEV_(1)/FVC)]、炎症因子[肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)]及术后并发症。结果:两组术后3 d的FVC、FEV_(1)、FEV_(1)/FVC均较术前有显著下降(P<0.05),术后3 d,A组FVC、FEV_(1)、FEV_(1)/FVC均明显高于B组(P<0.05)。两组术后3 d的TNF-α、IL-6、IL-1β水平均较术前有显著升高(P<0.05),术后3 d,A组TNF-α、IL-6、IL-1β水平明显低于B组(P<0.05)。A组术后并发症总发生率明显低于B组(P<0.05)。结论:将单肺通气保护策略应用于肺叶切除术中能有效减轻患者肺损伤,减轻机体炎症反应,保护患者肺功能,同时还能显著减少术后并发症发生。

Objective:To explore the application effect of one-lung ventilation (OLV) protection strategy in pulmonary lobectomy.Method:A total of 114 patients undergoing pulmonary lobectomy who were admitted to Quanzhou First Hospital Affiliated to Fujian Medical University from April 2019 to October 2020 were selected as the research subjects.They were randomly divided into group A (57 cases) and group B (57 cases).Both groups were treated with pulmonary lobectomy.Group B was treated with routine one-lung ventilation during operation,and group A was treated with one-lung ventilation protection strategy during operation.The lung function[forced vital capacity (FVC),forced expiratory volume in one second (FEV_(1)),FEV_(1)/FVC],inflammatory factors[tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),interleukin-1 β (IL-1β)]before and 3 d after operation and postoperative complications were compared between the two groups.Result:FVC,FEV_(1)and FEV_(1)/FVC in both groups were significantly decreased 3 d after operation compared with those before operation (P<0.05),3 d after operation,FVC,FEV_(1)and FEV_(1)/FVC in group A were significantly higher than those in group B (P<0.05).The levels of TNF-α,IL-6 and IL-1β in both groups were significantly increased 3 d after operation compared with those before operation (P<0.05),3 d after operation,the levels of TNF-α,IL-6 and IL-1β in group A were significantly lower than those in group B (P<0.05).The total incidence of postoperative complications in group A was significantly lower than that in group B (P<0.05).Conclusion:The application of one-lung ventilation protection strategy in pulmonary lobectomy can effectively reduce lung injury of patients,reduce the body’s inflammatory response,protect lung function of patients,and significantly reduce the occurence of postoperative complications.