肺保护性通气对单肺通气患者呼吸动力学、炎性因子及认知功能的影响

目的:探讨肺保护性通气对单肺通气(OLV)患者呼吸动力学、炎性因子及认知功能的影响。方法:选取2017年7月～2018年5月期间我院收治的择期行肺部手术的患者215例为研究对象。根据OLV方式的不同将患者分为传统OLV组(n=107)和保护性OLV组(n=108),比较两组OLV0.5 h(T1)、OLV1h(T2)等时间点的胸肺顺应性(CT)、气道阻力(Raw)、气道峰压(Ppeak)等指标情况,比较两组T1、T2、拔管后2 h(T3)白介素-6(IL-6)、白介素-8(IL-8)水平,比较两组术前、术后10 d第一秒用力呼气容积(FEV1)、一氧化碳弥散量(DLCO)、25%用力呼气流量(FEF25),比较两组术前、术后10 d、术后1个月简易精神状态量表(MMSE)评分,记录两组患者术后认知功能障碍发生率。结果:两组患者T2时间点CT均较T1时间点下降,但保护性OLV组高于传统OLV组(P0.05);两组患者T2时间点Raw、Ppeak较T1时间点升高,但保护性OLV组低于传统OLV组(P0.05)。两组患者T2、T3时间点IL-6、IL-8均较T1时间点升高,且T3时间点高于T2时间点(P0.05);保护性OLV组T2、T3时间点均低于传统OLV组(P0.05)。两组患者术前、术后1个月MMSE评分比较差异无统计学意义(P0.05);术后10 d,传统OLV组MMSE评分较术前、术后1个月降低,且术后10 d,保护性OLV组MMSE评分高于传统OLV组(P0.05);保护性OLV组术后认知功能障碍发生率显著低于传统OLV组(P0.05)。结论:OLV患者采用肺保护性通气的方式有助于改善患者呼吸动力学、肺功能以及认知功能,同时可以减轻机体炎性反应。

Effects of Lung Protective Ventilation on Respiratory Dynamics, Inflammatory Factors and Cognitive Function in Patients with One-lung Ventilation

ABSTRACT Objective: To investigate the effects of lung protective ventilation on respiratory dynamics,inflammatory factors and cognitive function in patients with one-lung ventilation (OLV). Methods: 215 patients with pulmonary diseases who underwent selective pulmonary surgery in our hospital from July 2017 to May 2018 were selected as subjects. The patients were divided into traditional OLV group (n=107) and protective OLV group (n=108) according to different ways of OLV. The lung-thoracic compliance (CT), airway resistance (Raw) and peak airway pressure (Peak) were compared at 0.5h (T1) and 1H (T2) of OLV between the two groups. The levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) were compared between the two groups. The forced expiratory volume (FEV1), carbon monoxide diffusion volume (DLCO) and 25% forced expiratory flow (FEF25) were compared between the two groups before operation and 10 d after operation. The Mini Mental State Scale (MMSE) score were compared between the two groups before operation, 10 d after operationand 1 months after operation. The incidence of postoperative cognitive dysfunction were recorded in the two groups. Results: The CT scan at T2 time point in both groups was lower than that at T1 time point, but the protective OLV group was higher than the traditional OLV group (P<0.05). The Raw and Peak at T2 time point in both groups were higher than those at T1 time point, but the protective OLV group was lower than the traditional OLV group (P<0.05). The levels of IL-6 and IL-8 at T2 and T3 time points in both groups were higher than those at T1 time point, and T3 time point was higher than that at T2 time point (P<0.05). The protective OLV group were lower than those in traditional OLV group at T1 time point and T3 time point(P<0.05). There were no significant differences in MMSE score between the two groups before operation and 1 months after operation (P>0.05). On the 10 d after operation, the MMSE score of traditional OLV group were lower than those of before operation and 1 months after operation. On the 10 d after operation, the MMSE score of protective OLV group was higher than that of traditional OLV group (P<0.05). The incidence of postoperative cognitive dysfunction in the protective OLV group was significantly lower than that in the traditional OLV group(P<0.05). Conclusion: Pulmonary protective ventilation in OLV patients can improve respiratory dynamics, pulmonary function and cognitive function. At the same time, it can reduce the inflammatory reaction.