| 摘要: |
| 目的探讨低潮气量反比通气联合PEEP对肺叶切除患者单肺通气时肺功能及炎症因子的影响。方法将80例择期行肺叶切除手术患者按随机数字表法分为常规通气组与反比通气组，每组40例，支气管插管全身麻醉后行机械通气，反比通气组吸呼比为2∶1，常规通气组吸呼比为1∶2。记录麻醉前（T0）、麻醉后5min（T1）、单肺通气开始（T2）、单肺通气45min（T3）及手术结束（T4）不同时点呼吸力学指标，采集T0、T3时点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T1、T3时点支气管肺泡灌洗液，用ELISA法检测IL-6、IL-8及IL-1β水平变化。结果与常规通气组比较，反比通气组动脉血氧分压（PaO2）、平均气道压和肺的顺应性（CL）明显增加，同时平台压降低，IL-6、IL-8及IL-1β释放减少（P＜0.05）。结论低潮气量反比通气联合PEEP可改善通气和低氧血症，增加肺的顺应性，降低平台压，减少炎症因子释放。 |
| 关键词: 反比通气 单肺通气 肺损伤 炎症因子 |
| DOI：10.12056/j.issn.1006-2785.2017.39.03.2016-428 |
| 分类号: |
| 基金项目:浙江省医学会临床科研基金（2015ZYC-A71） |
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| Effects of inverse ratio ventilation combined with PEEP on pulmonary function and inflammatory cytokine levels in patients undergoing pulmonary lobectomy during one-lung ventilation |
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REN Ming, ZHANG Wangping, ZHU Shengmei
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the First Affiliated Hospital，Zhejiang University School of Medicine
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| Abstract: |
| Objective To investigate the effects of inverse ratio ventilation (IRV) at a low tidal volume combined with combined positive end expiratory pressure (PEEP) on pulmonary function and inflammatory cytokine in patients undergoing
pulmonary lobectomy during one-lung ventilation. Methods Eighty patients undergoing pulmonary lobectomy with one-lung ventilation were randomly divided into IRV group(n=40) and control group(n=40)．Patients received general anesthesia, and were ventilated with different modes．Patients in IRV group were ventilated witha actual tidal volume (VT) of 7 ml/kg, respiratory rate of 12 breaths/min, I∶E of 2∶1,PEEP=5cmH20, in control group the I∶E was 1∶2 . Arterial blood was collected blood gas analysis． Meanwhile, respiratory mechanics were monitored and oxygenation index was calculated．The concentrations of IL-6, IL-8 and IL-1β in bronchoalveolar lavage fluid (BALF) were measured by enzyme-linked immunosorbent assay (ELISA). Results During one-lung ventilation the PaO2 was significantly higher in the IRV group than that in the control group (P＜0.05). Compared with the control group, the CL was significantly higher in the IRV group, while Pplat was lower (P＜0.05)．Additionally, levels of IL-6, IL-8 and IL-1β in BALF of IRV group were lower than those in control group (P＜0.05). Conclusion The inverse ratio ventilation (IRV)
combined with PEEP can improve ventilation and hypoxemia and reduce the inflammatory cytokine levels in patients undergoing pulmonary lobectomy with one-lung ventilation. |
| Key words: Inverse ratio ventilation One lung ventilation Lung injury Inflammatory cytokine |
