不同通气策略对老年患者腹部手术支气管肺泡灌洗液中肿瘤坏死因子α和白细胞介素8浓度的影响

摘要

Objective To investigate the effect of three ventilation strategies on tumor necrosis factor α (TNF-α) and interleukin 8 (IL-8) of bronchial veolar lavage fluid (BALF) in elder patients during abdominal surgery.Methods Ninety elder patients with abdominal surgery of First Affiliated Hospital of the Wenzhou medical university were seleeted,and divided into group Ⅰ (conventional tidal volume group),group Ⅱ (low water volume group) and group Ⅲ [low water volume ± positive and expiratory pressure (PEEP)],each group had 30 cases.BALF of 3 groups were selected after 3 min of intubation and anesthesia mechanical ventilation for 3 h,and TNF-α,IL-8 of BALF were detected.Results There were significant differences on TNF-α,1L-8 of 3 groups between anesthesia mechanical ventilation for 3 h and after 3 min of intubation (P ＜ 0.05) [group Ⅰ:(62 ± 4) μg/L vs (24 ±5)μg/L,(97 ±5)μg/L vs (42 ±5) μg/L; group Ⅱ:(38 ±4)μg/L vs (23 ±3)μg/L,(61 ±4)μg/L vs (44 ±5)μg/L;groupⅢ:(39 ±4) μg/L vs (24 ±4) μg/L,(69 ±5) μg/L vs (41 ±6)μg/L].TNF-α,IL-8 of group Ⅱ and group Ⅲ after anesthesia mechanical ventilation for 3 h were lower than that of group Ⅰ,there were significant differences (P ＜0.05).Conclusion For elder patients during abdominal surgery,three mechanical ventilation strategies can increase the levels of BALF TNF-α and IL-8,but these change are less in ventilation with low tidal volume than those in conventional ventilation with high tidal volume.%目的 探讨不同通气策略对老年患者腹部手术支气管肺泡灌洗液(BALF)中肿瘤坏死因子α(TNF-α)和白细胞介素8(IL-8)浓度的影响.方法 选择温州医科大学附属第一医院择期行腹部择期手术的老年患者90例,根据机械通气方式不同,完全随机分为Ⅰ组(常规潮气量组)、Ⅱ组(低潮气量组)和Ⅲ组(低潮气量±呼气末正压),每组30例于插管后3 min、麻醉机械通气3h收集BALF,检测BALF中TNF-α、IL-8水平.结果 3组患者插管后3h的TNF-α、IL-8与插管后3 min比较,差异均有统计学意义[Ⅰ组:(62±4) μg/L比(24±5) μg/L,(97±5)μg/L比(42±5)μg/L;Ⅱ组:(38±4)μg/L比(23±3)μg/L,(61±4) μg/L比(44±5)μg/L;Ⅲ组:(39±4)μg/L比(24 ±4) μg/L,(69±5) μg/L比(4l±6)μg/L](均P＜0.05).Ⅱ组和Ⅲ组插管后3 h的TNF-α、IL-8低于Ⅰ组,差异均有统计学意义(均P＜0.05)结论 在老年患者腹部手术中,低潮气量、低潮气量加小呼气末正压、常规潮气量均可引起老年患者BALF中TNF-α和IL-8水平升高,但常规潮气量更为显著.