|
| 肺保护性通气策略对老年患者腹腔镜结直肠癌手术的氧合功能及炎症介质的影响 |
| Effects of lung protective ventilation strategy on oxygenation and inflammatory mediators in elderly patients undergoing laparoscopic colorectal cancer surgery |
| 投稿时间：2019-03-10 修订日期：2019-03-15 |
| DOI： |
| 中文关键词: 肺保护性通气策略 老年 腹腔镜 结直肠 氧合 炎症介质 |
| 英文关键词: Pulmonary protective ventilation strategy elder Laparoscopy Colorectal Oxygenation Inflammatory mediators |
| 基金项目: |
|
| 摘要点击次数: 361 |
| 全文下载次数: 0 |
| 中文摘要: |
| 目的 探讨老年患者腹腔镜结直肠癌手术应用肺保护性通气策略对肺部氧合功能及炎症介质的影响。方法 选择我院2018年4月~2018年10月50例行择期腹腔镜结直肠癌根治术老年患者,ASA分级(美国麻醉医师协会体格情况评估分级)Ⅰ～Ⅱ级、年龄≥60岁,采用随机数字表法将50例受试者分为两组：VCV组和PCV组。在全麻机械通气过程中,VCV组采用传统容量控制通气模式,潮气量设置为8ml/kg;PCV组采用肺保护性通气策略,潮气量设置为6ml/kg及5cmH2O呼气末正压通气(( positive end expiration pressure,PEEP),同时气腹后每30min给予一次手法肺复张(气道压不超过30cmH2O,持续30秒)。记录患者气腹前5min(T0)、气腹后5min(T1)、气腹后30min(T2)气腹后60min(T3)气腹后120min(T4)气腹停止10min后(T5)的呼吸力学指标(潮气量,呼吸频率,气道峰压,气道平台压,呼气末CO2,肺顺应性),血流动力学指标(心率,收缩压,舒张压,平均动脉压,血氧饱和度);于T0、T4、离开苏醒室时抽取血气,计算氧合指数(OI)值,并于术前一天,T4,术后一天抽取静脉血,检测血浆CRP、IL-6的值。结果 两组患者性别、年龄、体重等一般情况和麻醉时间,手术时间,气腹时间,入液量,失血量及尿量差异无统计学意义(见表1)。与VCV组比较,PCV组在T4(t=0.035)、T5(t=0.039)时刻气道压降低,T3(t=0.012)、T4(t=0.001)、T5 (t=0.035)肺顺应性增高,差异有统计学意义(P＜0.05,见表2)。两组患者血流动力学指标差异无统计学意义。PCV组在离开苏醒室时氧合指数较高(t=0.04,P＜0.05,见表4)；PCV组在T4、术后一天时刻IL-6 (t=0.046,t=0.008)和CRP值(t=0.034,t=0.037)较低(P＜0.05,见表5)。结论 肺保护性通气策略可以提高老年患者肺部氧合功能,降低炎症介质释放,减轻肺损伤的发生。 |
| 英文摘要: |
| Objective To investigate the effect of lung protective ventilation strategy on pulmonary oxygenation and inflammatory mediators in elderly patients undergoing laparoscopic colorectal cancer surgery.Methods 50 elderly patients undergoing elective laparoscopic colorectal cancer radical operation in our hospital from April 2018 to October 2018 were selected,They were classified by ASA (American Society of Anesthesiologists Physical Assessment Grade) I-II and aged over 60 years.Fifty subjects were divided into two groups by random number table: VCV group and PCV group.During mechanical ventilation under general anesthesia, the VCV group adopted the traditional volume-controlled ventilation mode, and the tidal volume was set to 8 ml/kg PCV group adopted the lung protective ventilation strategy.Tidal volume was set to 6ml/kg and 5cmH2O positive end expiration pressure (PEEP), and manual pulmonary resuscitation was given every 30 minutes after pneumoperitoneum (airway pressure was no more than 30cmH2O, lasting 30 seconds).Hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation) and respiratory mechanics indexes (tidal volume, respiratory frequency, peak airway pressure, airway platform pressure, end-expiratory CO2, lung compliance) were recorded 5 minutes before pneumoperitoneum (T0), 5 minutes after pneumoperitoneum (T1), 30 minutes after pneumoperitoneum (T2), 60 minutes after pneumoperitoneum (T3) and 120 minutes after pneumoperitoneum (T4) stopped 10 minutes after pneumoperitoneum.Blood gas was extracted at T0, T4 and leaving PACU, and oxygenation index (OI) was calculated.Intravenous blood was taken one day before operation, T4 and one day after operation to detect the levels of CRP and IL-6 in plasma.Results There were no significant differences in general conditions such as sex, age, weight, anesthesia time, operation time, pneumoperitoneum time, fluid intake, blood loss and urine volume between the two groups (Table 1).Compared with VCV group, PCV group had lower airway pressure at T4 (t = 0.035), T5 (t = 0.039), T3 (t = 0.012), T4 (t = 0.001) T5 (t = 0.035) and higher lung compliance (P< 0.05) (Table 2)There was no significant difference in hemodynamic parameters between the two groups.Compared with VCV group, PCV group had a higher oxygenation index (t=0.04) when they left PACU (P<0.05),IL-6 and CRP in PCV group was lower at T4 (t = 0.046,t = 0.034), T5 (t = 0.008,(t = 0.037), (P< 0.05 )(Table 5) |
|
View Fulltext
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
