单肺通气期间延长吸气时间对患者肺损伤的影响

Effects of prolonged inspiratory time on lung injury in patients during one lung ventilation

目的:观察胸科胸腔镜下肺叶切除术中,单肺通气期间延长吸气时间对患者肺损伤的影响。方法:选择南通市第一人民医院2020年9月—2021年9月同组医师手术的患者50例,年龄20~65岁,ASAⅠ~Ⅱ级,均在全麻机械通气胸腔镜下行肺叶切除术,采用随机数表法分为对照组(C组,n=25)和观察组(E组,n=25)。单肺通气期间,C组吸呼比(inspiratory-to-expiratory ratio,I∶E)=1∶2;E组I∶E=1∶1。取单肺通气后切皮前(T_(0))、侧卧单肺通气后30 min(T_(1))、1 h(T_(2))3个时间点,抽取患者桡动脉血2 mL进行血气分析;抽取中心静脉血5 mL检测TNF-α、IL-6、IL-10水平,同时检测患者支气管肺泡灌洗液肺泡表面活性蛋白(surfactant protein,SP)-A、SP-D水平。结果:(1)与T_(0)相比,两组患者T_(2)时TNF-α明显升高(P<0.05),血清IL-6在T_(1)、T_(2)时均明显升高(均P<0.05)。(2)与T_(1)相比,两组患者的TNF-α、IL-6在T_(2)时明显升高(P<0.05)。(3)与C组相比,E组的TNF-α、IL-6在T_(2)时明显下降,IL-10在T_(2)时明显升高(P<0.05)。(4)与T_(0)相比,两组患者支气管肺泡灌洗液中的SP-A水平在T_(1)、T_(2)时明显升高,SP-D水平在T_(2)时明显升高(P<0.05);E组患者的SP-A及SP-D在T_(2)时明显较C组降低(P<0.05)。结论:单肺通气时延长吸气时间(I∶E=1∶1)可有效改善氧合,并在一定程度上减轻术中相关肺损伤。

Objective:To investigate the effect of prolonged inspiratory time during one-lung ventilation on lung injury in patients undergoing thoracic thoracoscopic lobectomy.Methods:50 patients from september 2020 to september 2021 in Nantong First People′s Hospital,aged 20-65 years old,ASAⅠ-Ⅱ,who underwent thoracoscopy lobectomy under general anesthesia,were randomly divided into control group(group C,25 cases)and observation group(group E,25 cases).During one lung ventilation group C keep the inspiratory-to-expiratory ratio(I∶E)at 1∶2 and group E changed I∶E to 1∶1.The arterial blood and central venous blood were collected in both groups immediately before incision(T_(0)),after 30 mins of one-lung ventilation(T_(1))and 1 h after one lung ventilation(T_(2)).The arterial blood were used for ABG analysis and the central venous blood were used to detect TNF-α,IL-6,IL-10.AT the same time bronchoalveolar lavage fluid were collected to detect surfactant protein(SP)-A and SP-D.Results:(1)Compared with T_(0),the levels of TNF-αin the two groups were significantly increased at T_(2)(P<0.05),and the serum IL-6 of the two groups were significantly increased at T_(1) and T_(2)(P<0.05).(2)Compared with T_(1),the levels of TNF-αand IL-6 in the two groups were significantly increased in T_(2)(P<0.05).(3)Compared with group C,TNF-αand IL-6 in group E were significantly decreased at T_(2),and IL-10 was significantly increased at T_(2).(4)Compared with T_(0),the levels of SP-A in the bronchoalveolar lavage fluid of the two groups were significantly increased at T_(1) and T_(2),and the level of SP-D was significantly increased at T_(2)(P<0.05);SP-A and SP-D in group E were significantly lower than those in group C at T_(2)(P<0.05).Conclusion:Prolonging the inspiratory time(I∶E=1∶1)during one-lung ventilation can effectively improve oxygenation and reduce intraoperative-related lung injury to a certain extent.