小潮气量联合呼气末正压对单肺通气肺内分流及炎性反应的影响

摘要

Objective To investigate the effects of small tidal volume combined with positive end-expiratory pressures on intrapulmonary shunt and inflammatory response during one lung ventilation (OLV). Methods Sixty patients undergoing esophageal cancer radical surgery were randomly divided into three groups with 20 each. Every patient received small tidal volume ventilation together with different PEEP levels(Group A:0 cm H2O;group B:5 cm H2O;group C: 10 cm H2O) during one lung ventilation. Intrapulmonary shunt was calculated and airway pressure was recorded. Peripheral blood cytokines were also detected. Results Intrapulmonary shunt and serum levels of TNF-α. 30 min, 60 min and 90 min after OLV increased when compared with those 30 min after two lung ventilation with more significance in group B(P<0. 05). Levels of IL-860 min and 90 min after OLV increased when compared with 30 min after two lung ventilation (P<0. 05). The oxygenation indexes 30 min, 60 min and 90 min after OLV in groups A and C were decreased compared with those 30 min after two lung ventilation. The oxygenation index in group B only decreased 30 min after OLV. The level of IL-1030 min, 60 min and 90 min after OLV in group B increased significantly compared with group A and C. Conclusion One lung ventilation (VT 6 ml/kg with PEEP 5 cm H2O) can reduce the intrapulmonary shunt, relieve inflammatory response, and improve oxygenation.%目的 研究单肺通气(OLV)时小潮气量联合呼气末正压(PEEP)对肺内分流及炎性反应的影响.方法 食管癌根治术患者60例,年龄20～65岁,随机均分为三组,OLV时患者VT均为6 ml/kg,PEEP分别为0cm H2O(A组)、5 cm H2O(B组)和10 cm H2O(C组).记录患者气道压变化,采集桡动脉血和深静脉血行血气分析并计算氧合指数(OI)和肺内分流率(Qs/Qt),采集外周静脉血进行炎性因子检测.结果 与双肺通气30 min时比较,三组OLV 30、60、90 min时Qs/Qt、肿瘤坏死因子α (TNF-α)、T2、T3时A、C组白细胞介素8(IL-8)明显增高(P＜0.05),但B组Qs/Qt、IL-8显著低于A、C组(P＜0.05).A、C组OLV 30、60、90 min时OI较双肺通气30 min时明显降低(P＜0.05)；B组仅在OLV 30 min时降低(P＜0.05).与A、C组比较,B组OLV 30、60、90 min时IL-10显著增高(P＜0.05).结论 OLV中VT 6 ml/kg联合PEEP 5 cm H2O)可以降低Qs/Qt,减轻炎性反应,改善氧合.