目的 比较不同频率肺复张术(RM)在单肺通气(OLV)患者中的应用效果.方法 选取2014年8月—2015年8月鄂东医疗集团市中医医院收治的拟行开胸手术及OLV的患者88例,根据RM频率分为A、B、C、D组,每组22例.OLV期间,A、B、C组患者RM频率分别为30 min/次、60 min/次、120 min/次,D组患者仅在关胸前行1次RM.比较4组患者手术相关指标(包括OLV时间、手术时间、补液量、失血量),OLV开始时(T1)、OLV30 min(T2)、OLV 1 h(T3)、OLV 2 h(T4)、OLV结束时(T5)、恢复双肺通气30 min(T6)氧合指数(OI)和肺内分流量(Qsp),T1、T3、T6、术后2 h(T7)、术后24 h(T8)血清肿瘤坏死因子α(TNF-α)和白介素6(IL-6)水平.结果 (1)4组患者OLV时间、补液量、失血量比较,差异无统计学意义(P＞0.05);B组患者手术时间短于A、C、D组(P＜0.05).(2)时间与方法在OI和Qsp上存在交互作用(P＜0.05);时间在OI和Qsp上主效应显著(P＜0.05);方法在OI和Qsp上主效应显著(P＜0.05).T2时,B、C、D组患者OI低于A组(P＜0.05);T3时,B组患者OI高于A、C、D组,C、D组患者OI低于A组(P＜0.05);T4时,B组患者OI高于A、C、D组,C、D组患者OI低于A组,D组患者OI低于C组(P＜0.05);T5、T6时,B组患者OI高于A、C、D组,C组患者OI高于A、D组,D组患者OI低于A组(P＜0.05).T2时,B、C、D组患者Qsp高于A组(P＜0.05);T3时,B、C、D组患者Qsp高于A组,B组患者Qsp低于C、D组(P＜0.05);T4、T5时,B组患者Qsp低于A、C、D组,C、D组患者Qsp高于A组,D组患者Qsp高于C组(P＜0.05);T6时,B组患者Qsp低于A、C、D组,C组患者Qsp低于A、D组,D组患者Qsp高于A组(P＜0.05). (3)时间与方法在血清TNF-α和IL-6水平上存在交互作用(P＜0.05);时间在血清TNF-α和IL-6水平上主效应显著(P＜0.05);方法在血清TNF-α和IL-6水平上主效应显著(P＜0.05).T3时,B、C、D组患者血清TNF-α水平低于A组,B组患者血清TNF-α水平高于C、D组(P＜0.05);T6、T7、T8时,B、C、D组患者血清TNF-α水平低于A组,B组患者血清TNF--α水平低于C、D组,D组患者血清TNF--α水平高于C组(P＜0.05).T3时,B、C、D组患者血清IL-6水平低于A组,B组患者IL-6水平高于C、D组(P＜0.05);T6、T7、T8时,B、C组患者血清IL-6水平低于A组,B组患者IL-6水平低于C、D组,D组患者血清IL-6水平高于C组(P＜0.05).结论 OLV期间每60 min行1次RM可有效改善OLV患者肺氧合功能,降低Qsp并减轻炎性反应,应用效果较佳.%Objective To compare the application effect of different frequencies of recruitment maneuver on one-lung ventilation (OLV).Methods A total of 88 patients prepared for thoracotomy and OLV were selected in the Municipal Traditional Chinese Medicine Hospital of Edong Medical Group from August 2014 to August 2015,and they were divided into A group (received recruitment maneuver with interval of 30 minutes per time),B group (received recruitment maneuver with interval of 60 minutes per time),C group (received recruitment maneuver with interval of 120 minutes per time) and D group (received recruitment before closing thoracic cavity only) according to the recruitment maneuver frequency during OLV,each of 22 cases.Surgical indicators (including duration of OLV,duration of surgery,volume of fluid input and blood loss volume),oxygenation index (OI) and intrapulmonary shunt volume (Qsp) at the begin of OLV (T1),after 30 minutes of OLV (T2),after 1 hours of OLV (T3),after 2 hours of OLV (T4),at the end of OLV (T5) and after 30 minutes of restoring dual lung ventilation (T6),serum levels of TNF-α and IL-6 at T1,T3 and T6,after 2 hours of surgery (T7),after 24 hours of surgery (T8).Results (1) No statistically significant differences of duration of OLV,volume of fluid input or blood loss volume was found among the four groups (P ＞0.05),while duration of surgery of B group was statistically significantly shorter than that of A group,C group and D group,respectively (P ＜ 0.05).(2) There was interaction in OI and Qsp between time and method (P ＜ 0.05);main effects of time and method were significant in OI and Qsp (P ＜ 0.05).At T2,OI of B group,C group and D group was statistically significantly lower than that of A group,respectively (P ＜ 0.05);at T3,OI of B group was statistically significantly higher than that of A group,C group and D group,respectively,meanwhile OI of C group and D group was statistically significantly lower than that of A group,respectively (P ＜ 0.05);at T4,OI of B group was statistically significantly higher than that of A group,C group and C group,respectively,meanwhile OI of C group and D group was statistically significantly lower than that of A group,respectively,OI of D group was statistically significantly lower than that of C group (P ＜ 0.05);at T5 and T6,OI of B group was statistically significantly higher than that of A group,C group and D group,respectively,meanwhile OI of C group was statistically significantly higher than that of A group and D group,OI of D group was statistically significantly lower than that of A group (P ＜ 0.05).At T2,Qsp of B group,C group and D group was statistically significantly higher than that of A group,respectively (P ＜ 0.05);at T3,Qsp of B group,C group and D group was statistically significantly higher than that of A group,respectively,meanwhile Qsp of B group was statistically significantly lower than that of C group and D group,respectively (P ＜ 0.05);at T4 and T5,Qsp of B group was statistically significantly lower than that of A group,C group and D group,respectively,meanwhile Qsp of C group and D group was statistically significantly higher than that of A group,respectively,Qsp of D group was statistically significantly higher than that of C group (P ＜ 0.05);at T6,Qsp of B group was statistically significantly lower than that of A group,C group and D group,respectively,Qsp of C group was statistically significantly lower than that of A group and D group,respectively,Qsp of D group was statistically significantly higher than that of A group (P ＜ 0.05).(3) There was interaction in serum levels of TNF-α and IL-6 between time and method (P ＜ 0.05);main effects of time and method were significant in serum levels of TNF-α and IL-6 (P ＜ 0.05).At T3,serum TNF-α level of B group,C group and D group was statistically significantly lower than that of A group,respectively,meanwhile serum TNF-α level of B group was statistically significantly higher than that of C,D group (P ＜0.05);at T6,T7 and T8,serum TNF-α level of B group,C group and D group was statistically significantly lower than that of A group,respectively,meanwhile serum TNF-α level of B group was statistically significantly lower than that of C,D group,respectively,serum TNF-α level of D group was statistically significantly higher than that of C group (P ＜0.05).At T3,serum IL-6 level of B group,C group and D group was statistically significantly lower than that of A group,respectively,meanwhile serum IL-6 level of B group was statistically significantly higher than that of C,D group,respectively (P ＜ 0.05);at T6,T7 and T8,serum IL-6 level of B group and C group was statistically significantly lower than that of A group,respectively,meanwhile serum IL-6 level of B group was statistically significantly lower than that of C group and D group,respectively,serum IL-6 level of D group was statistically significantly higher than that of C group (P ＜ 0.05).Conclusion Recruitment maneuver with interval of 60 minutes per time during OLV has better application effect in patients undergoing thoracotomy,can effectively improve the pulmonary oxygenation function,reduce the Qsp and relievethe inflammatory reaction.
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