保护性双肺复张通气在行手术治疗肺癌患者中的应用

Protective dual lung re-expansion ventilation in lung cancer resection

目的探讨保护性双肺复张通气对行手术治疗肺癌患者血流动力学及血清白细胞介素(interleukin, IL)-6、IL-8水平的影响。方法行手术治疗肺癌患者124例,依据术中通气方法分为观察组和对照组各62例。对照组给予单肺通气,观察组在对照组基础上同时行保护性双肺复张通气。记录2组单肺通气时间、手术时间、术后拔管时间、术后住院时间及术后7 d并发症发生率,比较2组单肺通气前(T_1)、单肺通气1 h(T_2)、术毕(T_3)时心率、平均动脉压(mean arterial pressure, MAP)及血清IL-6、IL-8水平。结果观察组术后拔管时间较对照组早,术后住院时间较对照组短(P<0.05),2组单肺通气时间、手术时间比较差异无统计学意义(P>0.05);观察组、对照组T_1、T_2、T_3心率及MAP在组内及组间比较差异均无统计学意义(P>0.05);观察组T_1血清IL-6[(14.20±2.93)ng/L]、IL-8[(4.20±1.48)ng/L]与对照组[(14.09±3.82)、(4.21±1.22)ng/L]比较差异无统计学意义(P>0.05),T_2、T_3血清IL-6[(19.02±2.48)、(21.88±5.30)ng/L]、IL-8[(7.94±2.78)、(9.28±2.44)ng/L]低于对照组[IL-6:(32.49±3.10)、(33.20±4.30)ng/L;IL-8:(11.48±3.11)、(14.82±3.77)ng/L](P<0.05);观察组术后7 d并发症发生率(4.8%)低于对照组(19.4%)(P<0.05)。结论保护性双肺复张通气可减弱肺癌患者手术过程中炎性反应,保持血流动力学稳定,减少术后并发症,促进患者康复。

Objective To investigate the influence of protective dual lung re-expansion ventilation on hemodynamic indexes,serum interleukin(IL)-6 and IL-8 in patients undergoing lung cancer resection.Methods Totally 124 patients undergoing lung cancer resection were divided into observation group and control group according to ventilation method.Control group was given one-lung ventilation,and observation group was given protective dual lung re-expansion ventilation on the basis of one-lung ventilation.The one-lung ventilation time,operative time,postoperative extubation time,postoperative hospital stay and complications on the postoperative 7 th day were recorded in two groups.The heart rate,mean arterial pressure(MAP),and serum levels of IL-6 and IL-8 were compared between two groups at the time points of before one-lung ventilation(T1),1 h after one-lung ventilation(T2)and after surgery(T3).Results The postoperative extubation time was earlier and the postoperative hospital stay was shorter in observation group than that in control group(P<0.05).The one-lung ventilation time and operative time showed no significant differences between two groups(P>0.05).The heart rate and MPR showed no significant differences at T1,T2 and T3 as well as between two groups.The levels of IL-6 and IL-8 showed no significant differences between observation group((14.20±2.93),(4.20±1.48)ng/L)and control group((14.09±3.82),(4.21±1.22)ng/L)(P>0.05).The serum levels of IL-6((19.02±2.48),(21.88±5.30)ng/L)and IL-8((7.94±2.78),(9.28±2.44)ng/L)at T2 and T3 in observation group were significantly lower than those in control group((32.49±3.10),(33.20±4.30)ng/L;(11.48±3.11),(14.82±3.77)ng/L)(P<0.05).The incidence of complication was significantly lower in observation group(4.8%)than that in control group(19.4%)(P<0.05).Conclusion Protective dual lung ventilation can inhibit serum inflammatory response,maintain hemodynamic stability,reduce postoperative complications and promote rehabilitation of the patients undergoing lung cancer resection.