持续气道正压对胸腹腔镜联合食管癌根治术后肺损伤的影响

发布时间：2018-05-02 00:18

本文选题：持续气道正压 + 肺损伤　；参考：《第三军医大学学报》2015年23期

【摘要】：目的观察单肺通气时,萎陷侧肺持续气道正压(continuous positive airway pressure,CPAP)对胸腹腔镜联合食管癌根治术后肺损伤的影响。方法择期行胸腹腔镜联合食管癌根治术患者50例,ASA评分Ⅱ~Ⅲ级,年龄40~75岁,体质指数(BMI)18~27,按随机数字表法分为2组(n=25):对照组,即单肺通气时萎陷侧肺及气道向大气开放;CPAP组,即单肺通气时向萎陷侧肺持续输送纯氧维持萎陷侧肺及气道压力为6 cm H2O。分别于T1(麻醉开始前)、T2(单肺通气结束时)和T3(术后24 h)抽取患者的静脉血3 m L,用ELISA法检测血清晚期糖基化代谢产物(soluble receptor of advanced glycation end-products,sRAGE)和KL-6(krebs.von den Iungen-6)水平,同时抽取动脉血2 m L行血气分析,并计算氧合指数(oxygenation index,OI)。结果氧合指数:对照组、CPAP组于T2、T3时点,氧合指数比T1时点均显著降低(P0.05);在T2时点,CPAP组氧合指数比对照组显著升高(P0.05)。sRAGE和KL-6水平:CPAP组和对照组在T3时点与T1时点、T2时点比较sRAGE和KL-6水平均显著升高(P0.05);在T3时点,与对照组比较,CPAP组sRAGE和KL-6水平显著降低(P0.05)。结论单肺通气时萎陷侧肺保持持续气道正压能减轻胸腹腔镜联合食管癌根治术所致肺损伤。
[Abstract]:Objective To observe the effect of continuous positive airway pressure (CPAP) on lung injury after thoracoscopic laparoscopy combined with radical resection of esophageal cancer in single lung ventilation. Methods 50 patients with thoracic laparoscopy combined with esophageal cancer radical resection, ASA score II ~ III, 40~75 age, and mass index (BMI) 18~27, according to random numbers, were observed. The table method was divided into 2 groups (n=25): the control group, that was, the lung and the airway were open to the air and the airway in the single lung ventilation. In group CPAP, the continuous delivery of pure oxygen to the collapsed side lung and the airway pressure during the single lung ventilation was 6 cm, respectively, T1 (before the start of the anesthesia), T2 (Dan Feitong gas end) and T3 (24 h after the operation) and 3 m L of the patient's venous blood, using ELI. The levels of serum advanced glycosylated metabolites (soluble receptor of advanced glycation end-products, sRAGE) and KL-6 (krebs.von den Iungen-6) were detected by SA method, and the blood gas analysis was extracted by 2 arterial blood, and the oxygenation index was calculated. At T2 point, the oxygenation index of group CPAP was significantly higher than that of the control group (P0.05).SRAGE and KL-6 level: CPAP group and control group at T3 time point and T1 time point, T2 time point comparison sRAGE and KL-6 water increased significantly (P0.05); at the time point, compared with the control group, the level of single lung ventilation was significantly lower. Conclusion single lung ventilation was found. Conclusion single lung ventilation was found at the point of time. Continuous positive airway pressure can reduce lung injury caused by thoracoscopic and laparoscopic radical esophagectomy.

【作者单位】：重庆医科大学附属第一医院麻醉科;
【基金】：重庆市卫生局课题(2011-2-119) 国家临床重点专科建设项目(财社〔2011〕170号) 重庆医学重点学科建设项目(渝卫科教〔2007〕2号)~~
【分类号】：R735.1

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