胸腔镜单肺通气心脏手术与开胸心脏手术肺损伤比较

发布时间：2018-04-28 15:15

本文选题：胸腔镜检查 + 心脏手术　；参考：《重庆医学》2017年29期

【摘要】：目的比较胸腔镜单肺通气(OLV)心脏手术和开胸心脏手术的肺损伤情况。方法选取该院2013年5月至2015年12月行开胸直视心脏手术及胸腔镜心脏手术的患者60例,将其分为观察组与对照组,各30例。对照组采用单腔气管导管行双肺通气,观察组术中采用双腔管行左肺OLV。于麻醉诱导后(T1)、体外循环(CPB)前(T2)、CPB开始后即刻(T3)、CPB停机后30min(T4)、CPB停机后60min(T5)测定动脉血气分析指标,计算呼吸指数(RI),测定血浆细胞间黏附分子-1(ICAM-1)及肺泡表面活性蛋白A(SP-A)水平;术中采集肺组织,检测肺组织核转录因子-κB(NF-κB)表达水平,并进行肺组织病理分析。结果观察组T3、T4、T5时动脉氧分压低于对照组,T2、T3、T4、T5时RI高于对照组,差异均有统计学意义(P0.05)。术后两组ICAM-1、NF-κB水平均增高,且观察组高于对照组(P0.05)。术后两组SP-A水平均降低,且观察组低于对照组(P0.05)。肺组织病理显示,观察组肺泡肿胀、中性粒细胞浸润,间质渗出,炎症表现比对照组更明显。结论胸腔镜OLV心脏手术较开胸心脏手术肺损伤更明显。
[Abstract]:Objective to compare the lung injury between thoracoscopic single lung ventilation (OLVV) and open chest surgery. Methods from May 2013 to December 2015, 60 patients with open heart surgery and thoracoscopic heart surgery were selected and divided into two groups: the observation group (n = 30) and the control group (n = 30). The patients in the control group were treated with double lung ventilation with single lumen tracheal catheter, and the patients in the observation group were treated with left lung OLV with double lumen tube. After anesthesia induction, T _ (1), T _ (2) T _ (2) and CPB (30 min after CPB stopped, 60 min after CPB) were used to determine arterial blood gas analysis, respiratory index (RI), plasma intercellular adhesion molecule-1 (-1ICAM-1) and alveolar surface active protein (AHS-SP-A) were measured. Lung tissue was collected during operation and the expression of NF-魏 B was detected. Results the arterial oxygen partial pressure in the observation group was lower than that in the control group at T _ 3 T _ 4 T _ 5, and the RI at T _ 2 T _ 3T _ 4 T _ 4 T _ 5 was significantly higher than that in the control group (P 0.05). The level of ICAM-1 NF- 魏 B in the two groups was higher than that in the control group (P 0.05). The level of SP-A in the observation group was lower than that in the control group (P 0.05). Lung histopathology showed that alveolar swelling, neutrophil infiltration, interstitial exudation and inflammation were more obvious in the observation group than in the control group. Conclusion the lung injury of thoracoscopic OLV heart surgery is more obvious than that of open heart surgery.
【作者单位】：重庆市人民医院中山院区麻醉科;
【基金】：重庆市卫生局医学科研基金资助项目(20130016)
【分类号】：R614

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