Objective To observe the changes of TNF‐α,interleukin IL‐6 ,IL‐10 and gas analysis though one lung ventilationone with two different pattern to study the effects lung injury and values of oxygenation on patients undergoing esophageal surgery . Methods 60 patients with esophageal cancer were randomly divided into two groups of A and B with 30 cases each .A term :contin‐ual one lungventilation and 4 cm H2 O peep until the end operate ,B term :intermittent one lung ventilation each 45 min with two lung ventilation 5 min .Blood gas analysis were determined immediately before one lung ventilation ,30 min following OLV ,60 min following OLV ,90 min following OLV ,120 min following OLV ,the end of the OLV ,after operate 24 h observe the MAP ,HR ,P , R ,SpO2 .PETCO2 and airway peak were recorded during operate .Results (1)SpO2 in group A was decreased at T3 and reached lest level at T5 ,which was higher than that in group B at T3 ,T5(P<0 .05) .(2)the levels of IL‐6 ,TNF‐α and IL‐10 in the two groups began to rise at T3(P<0 .01) ,reached peak level at T6 ,and decreased gradually at T7 ,which were still higher than those at T1(P<0 .05) .(3) The levels of TNF‐αand IL‐6 were lower in group A than those in g roup B at T3-T6(P<0 .05) ,T1 ,T2 ,T7 (P>0 .05) .The levels of IL‐10 was higher in group A than those in group B at T3-T7(P<0 .05) .Conclusion Compared with A term ,B term without VT has more lung injury although it increases values of oxygenation .%目的：通过对单肺通气（OLV）患者采用不同通气模式，观察炎症细胞因子、气道压的变化，探讨不同OLV模式对患者炎性反应和动脉氧合的影响。方法选择开胸手术食管中段癌患者60例，年龄45～65岁，BM I 18～26 kg/m2，均分为2组。A组为开胸后持续OLV联合4 cm H2 O呼吸末正压至关胸，B组为开胸后OLV联合4 cm H2 O呼吸末正压间隔45 min膨双肺5 min。分别于OLV前（T1），OLV 30 min（T2）、60 min（T3）、90 min（T4）、OLV结束前（T5）、出室前（T6）及术后24 h（T7）时间点记录患者平均动脉压（MAP）、心率（HR）、血氧饱和度（SPO2）和脑电双频指数（BIS）、气道压，并采集颈内静脉血5 mL进行炎症因子检测；分别于T1、T2、T3、T4、T5时点记录患者呼气末二氧化碳分压（PETCO2）、气道压峰值（Peak）并取桡动脉采血3 mL行血气分析。结果（1）两组血氧分压（PO2）于时T2开始下降，T5时降至最低，T3、T4、T5时 A组低于B组，差异有统计学意义（P＜0．05）。SPO2两组间差异无统计学意义（P＞0．05）。（2）两组肿瘤坏死因子α（TNF‐α）和IL‐6、IL‐10的浓度均在 T3时刻开始明显上升（P＜0．01）、T6时刻达高峰、T7降低但仍高于T1时水平。（3）两组间 TNF‐α、IL‐6在 T3、T4、T5、T6时A组低于B组（P＜0．05），T1、T2、T7时组间差异无统计学意义（P＞0．05），而IL‐10在T3、T4、T5、T6、T7时A组高于B组，组间比较差异有统计学意义（P＜0．05）。结论开胸手术患者术中行OLV期间间断膨肺虽然改善了氧合但反复肺萎陷复张所导致的肺部炎性反应更严重。
展开▼
