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血浆炎症介质水平的影响

目的:探讨肺保护通气策略对老年患者行腹腔镜结直肠癌根治术肺部氧合功能及血清炎症介质水平的影响。方法:选择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其分为两组:VCV组和PCV组。在围术期行全麻机械通气中,VCV组采用容量通气模式,潮气量为8 m L/kg,PCV组采用肺保护通气,潮气量为6 m L/kg及5 cm H2O呼气末正压通气(positive end expiration pressure,PEEP),同时气腹后每30 min给予一次手法肺复张。记录患者气腹前5 min(T0)、气腹后5 min(T1)、气腹后30 min(T2)、气腹后60 min(T3)、气腹后120 min(T4)、气腹停止10 min后(T5)的呼吸力学指标、血流动力学指标于T0、T4、离开苏醒室时抽取血气,计算氧合指数(OI)值,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:与VCV组比较,PCV组在T4、T5时刻气道压降低,T4、T5肺顺应性增高(P<0.05)。两组患者血流动力学指标无明显差异。PCV组在离开苏醒室时氧合指数较高(P<0.05);PCV组在术后一天时刻IL-6和CRP值较低(P<0.05)。结论:肺保护性通气策略可以提高老年患者肺部氧合功能,减少炎症介质释放,减轻肺损伤。

Effect of Lung Protective Ventilation Strategy on the Oxygenation and Inflammatory Mediators in the Elderly Patients undergoing Laparoscopic Colorectal Cancer Surgery

ABSTRACT Objective: To investigate the effect of lung protective ventilation strategy on pulmonary oxygenation function and serum inflammatory mediators in elderly patients undergoing laparoscopic colorectal cancer surgery. Methods: 50 elderly patients undergoing elective laparoscopic colorectal cancer radical operation were classified by ASA (American Society of Anesthesiologists Physical Assessment Grade) I-II and aged over 60 years. They 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 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 6 mL/kg and 5 cm H₂O positive end expiration pressure (PEEP), and manual pulmonary resuscitation was given every 30 minutes after pneumoperitoneum Hemodynamic parameters and respiratory mechanics indexes were recorded at 5 minutes before pneumoperitoneum (T₀), at 5 minutes after pneumoperitoneum (T₁), at 30 minutes after pneumoperitoneum (T₂), at 60 minutes after pneumoperitoneum (T₃) and at 120 minutes after pneumoperitoneum (T₄) stopped at 10 minutes after pneumoperitoneum. Blood gas was extracted at T₀, T₄ and leaving PACU, and oxygenation index (OI) was calculated. Intravenous blood was taken at one day before operation, at T₄ and one day after operation to detect the levels of CRP and IL-6 in plasma. Results: Compared with VCV group, PCV group had lower airway pressure at T₄, T₅ and higher lung compliance at T₄, T₅ (P<0.05). There was no significant difference in hemodynamic parameters between the two groups. Compared with VCV group, PCV group had a higher oxygenation index when they left PACU (P<0.05), IL-6 and CRP in PCV group was lower at one day after operation(P<0.05). Conclusion: Pulmonary protective ventilation strategy can improve the pulmonary oxygenation function, reduce the release of inflammatory mediators and the occurrence of lung injury in elderly patients.