摘要
目的探讨两种通气策略(低潮气量+小PEEP机械通气及常规大潮气量)对老年病人腹部手术短期机械通气肺外周血白细胞介素-6(IL-6)、白细胞介素-8(IL-8)的影响。方法选择腹部择期手术的老年患者(年龄>60岁,ASAⅠ～Ⅱ级)40例,根据机械通气方式不同,随机分为两组。LV+P组(A组):低潮气量+小PEEP(呼气末正压),潮气量(VT)为7 ml/kg PBW(预测体重),PEEP为5 cmH2O;常规大潮气量组(B组),VT 12 ml/kg PBW,PEEP为0。分别于气管插管后机械通气5 min、3 h这2个时点,采集静脉血测定血清IL-6、IL-8浓度。结果两组肺顺应性(CL)均随着时间延长呈下降趋势,B组明显低于A组(P<0.01)。机械通气3 h时A组肺外周血IL-6、IL-8增加量较B组明显降低(P=0.000,P=0.002)。结论在老年病人腹部手术中低潮气量加小PEEP机械通气与常规大潮气量均可引起老年病人血浆IL-6和IL-8水平升高,肺顺应性降低,但低潮气量加小PEEP可以减轻该变化。
Objective To investigate the effect of two ventilation strategies on lung compliance and blood IL- 6,IL-8 in elder patients during abdominal surgery. Methods Forty ASA Ⅰ-Ⅱ elder patients, aged 〉 60 years, scheduled for selective abdominal operation under general anesthesia were divided into two groups randomly ： group A （VT 7ml/kg PBW） PEEP was 5 emil2 O; group B （VT 12 ml/kg PBW）. Pressure controlled ventilation was per- formed after tracheal intubation, P^rCO2 was maintained at normal range through respiratory rate adjusted（RR）. HR, MAP,SpO2 ,PET CO2 ,CL were monitored continuously and recorded at 5 rain（T0） ,30 rain（T1） ,1 h（T2） ,3 h（T3） after tracheal intubation;the serum levels of the interleukins IL-6 and IL-8 were monitored at 5 min and 3 h after venti- lation strategies. Results There were no significant differences in HR, MAP and PrrCO2 between the two groups （P 〉0. 05 ） ; and CL in group B was lower than that in the group A（P 〈 0. 01 ）. Levels of the blood interleukins IL-6 and IL-8 in group A were decreased compared with the B group at 3 h after ventilation strategies （ P = 0. 000, P = 0. 002）. Conclusion For eider patients during abdominal surgery, two mechanical ventilotion strategies can incr- ease the levels of blood IL-6 and IL-8 and decrease CL, but these change are less in meehanieal ventilation with low tidal volume than that in conventional ventilation with high tidal volume.
出处
《中国临床新医学》
2012年第9期824-826,共3页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
广西自然科学基金资助项目(编号:桂科自0640060)
关键词
机械通气
低潮气量
肺顺应性
炎性因子
Ventilation
Low tidal volumes
Lung eomplianee
Inflammatory factor
