反比通气联合PEEP对肺叶切除患者单肺通气时肺功能的影响

发布时间：2018-04-17 07:40

本文选题：反比通气 + 单肺通气　；参考：《临床麻醉学杂志》2017年03期

【摘要】：目的探讨反比通气联合PEEP对肺叶切除患者单肺通气时肺功能及炎症因子的影响。方法选择择期行肺叶切除术单肺通气的患者80例,男52例,女28例,年龄37~65岁,BMI21~29kg/m~2,ASAⅡ级,随机分为反比通气组与常规通气组,每组40例。支气管插管全麻后机械通气,反比通气组为I∶E 2∶1,VT7mL/kg,RR 12次/分,PEEP 5mH_2O;常规通气组为I∶E 1∶2,其他参数不变。记录麻醉前(T0)、麻醉后5min(T_1)、单肺通气开始(T_2)、单肺通气45 min(T_3)及手术结束(T4)的呼吸力学指标,采集T_0、T_3时的动脉血和中心静脉血进行血气分析,计算氧合指数(OI)。用纤维支气管镜采集T_1、T_3时支气管肺泡灌洗液,采用ELISA法检测IL-6、IL-8及IL-10浓度的变化。结果与常规通气组比较,T_3时反比通气组PaO_2明显升高(P0.05);T1~T4时反比通气组气道峰压(Ppeak)和气道平台压(Pplat)明显降低(P0.05),PEEP和平均气道压(Pmean)明显升高(P0.05),肺的顺应性(CL)明显增加(P0.05);T3时反比通气组IL-6、IL-8和IL-10浓度明显降低(P0.05)。低氧血症常规通气组2例(5.0%),反比通气组1例(2.5%),两组差异无统计学意义。两组均未见苏醒延迟、肺不张和气胸等并发症。结论反比通气联合PEEP可改善通气和低氧血症,增加肺的顺应性,降低气道平台压,抑制炎症因子释放。
[Abstract]:Objective to investigate the effects of inverse ratio ventilation (RPV) combined with PEEP on pulmonary function and inflammatory factors in patients with single lung ventilation.Methods A total of 80 patients (52 males and 28 females) with selective pulmonary lobectomy were randomly divided into two groups (40 cases in each group).After general anesthesia, I: e 2: 1 VT 7 mL / kg RR 12 times / min peep 5mH 2O, I: e 1: 2, other parameters unchanged.The respiratory mechanical indexes of T _ 0 and T _ 4 were recorded before anesthesia, 5 min after anesthesia, 5 min after anesthesia, 5 min after anesthesia, 1 min after one-lung ventilation, 45 min after one-lung ventilation, and 45 min after operation. The arterial blood and central venous blood at T _ 0 / T _ 3 were collected for blood gas analysis, and the oxygenation index (Oi) was calculated.Bronchoalveolar lavage fluid (BALF) was collected by fiberoptic bronchoscopy and the concentration of IL-6 IL-8 and IL-10 were detected by ELISA method.Results compared with the routine ventilation group, the PaO_2 in the tiaph group was significantly higher than that in the conventional ventilation group. The peak airway pressure (Ppeak) and the airway plateau pressure (plati) in the reverse ratio ventilation group (P 0.05) and the mean airway pressure (P mean) were significantly lower than those in the normal ventilation group (P 0.05), and the lung compliance index was significantly increased at the time of P 0.05 and T 3.The concentration of IL-6 IL-8 and IL-10 in the reverse ratio ventilation group was significantly lower than that in the control group (P 0.05).There was no significant difference between the two groups in hypoxemia routine ventilation group (n = 2) and inverse ratio ventilation group (n = 1).There were no complications such as delayed recovery, atelectasis and pneumothorax in both groups.Conclusion inverse ratio ventilation combined with PEEP can improve ventilation and hypoxemia, increase lung compliance, reduce airway plateau pressure and inhibit inflammatory factor release.
【作者单位】：嘉兴市妇幼保健院麻醉科;
【基金】：浙江省医学会临床科研基金(2015ZYC-A71)
【分类号】：R614

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