反比通气联合PEEP对肺叶切除患者单肺通气时肺功能的影响

摘要

目的 探讨反比通气联合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 选择择期行肺叶切除术单肺通气的患者80例,男52例,女28例,年龄37~65岁,BMI 21~29 kg/m2,ASA Ⅱ级,随机分为反比通气组与常规通气组,每组40例.支气管插管全麻后机械通气,反比通气组为I:E 2:1,VT 7 mL/kg,RR 12次/分,PEEP 5 mH2O;常规通气组为I:E 1:2,其他参数不变.记录麻醉前(T0)、麻醉后5 min(T1)、单肺通气开始(T2)、单肺通气45 min(T3)及手术结束 (T4)的呼吸力学指标,采集T0、T3时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时支气管肺泡灌洗液,采用ELISA法检测IL-6、IL-8及IL-10浓度的变化.结果 与常规通气组比较,T3时反比通气组PaO2明显升高(P<0.05);T1~T4时反比通气组气道峰压(Ppeak)和气道平台压(Pplat)明显降低(P<0.05),PEEP和平均气道压(Pmean)明显升高(P<0.05),肺的顺应性(CL)明显增加 (P<0.05);T3时反比通气组IL-6、IL-8和IL-10浓度明显降低(P<0.05).低氧血症常规通气组2例(5.0%),反比通气组1例(2.5%),两组差异无统计学意义.两组均未见苏醒延迟、肺不张和气胸等并发症.结论 反比通气联合PEEP可改善通气和低氧血症,增加肺的顺应性,降低气道平台压,抑制炎症因子释放.%Objective To investigate the effects of inverse ratio ventilation with positive end expiratory pressure (PEEP) on pulmonary function and inflammatory cytokine in patients undergoing pulmonary lobectomy during one-lung ventilation.Methods Eighty patients with one-lung ventilation,52 males,28 females,aged 37-65 years,BMI 21-29 kg/m2,ASA grade Ⅱ,were randomly divided into inverse ratio ventilation (IRV) group and conventional ventilation (CV) group (n=40 each).Patients were all implemented into the program of general anesthesia,and ventilated with different modes.The IRV group were ventilated with a actual tidal volume (VT) of 7 ml/kg,respiratory rate of 12 breaths/min,I:E of 2:1,PEEP 5 cm H2O;in CV group with I:E of 1:2.Respiratory parameters were recorded at baseline (T0),5 min after anesthesia (T1),initiate of one-lung ventilation (T2),45 min of one-lung ventilation (T3) and the end of surgery (T4).Arterial blood was collected to analyze blood gas at T0 and T3 respectively.Meanwhile,oxygenation index was calculated.The concentrations of IL-6,IL-8 and IL-10 in bronchoalveolar lavage fluid (BALF) were measured with fiberoptic bronchoscope by enzyme-linked immunosorbent assay (ELISA).Results Compared with CV group,PaO2was significantly increased and levels of IL-6,IL-8 and IL-10 in BALF were significantly decreased at T3 in IRV group (P<0.05);Ppeak and Pplat were significantly decreased at T1-T4 in IRV group (P<0.05);PEEP,Pmean and CL at T1-T4 were significantly increased at T1-T4 in IRV group (P<0.05).Two cases (5.0%) of hypoxemia were found in CV group,one case (2.5%) of hypoxemia was found in IRV group,but there were no statistically significant differences in both groups.Two groups were not seen to complications such as delay,atelectasis and pneumothorax.Conclusion The oxygenation and hypoxemia were improved and inflammatory cytokine was released in patients with one-lung ventilation.