| 摘要: |
| ［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。 |
| 关键词: 机械通气 低潮气量 肺顺应性 炎性因子 |
| DOI：10.3969/j.issn.1674-3806.2012.09.06 |
| 分类号:R 614 |
| 基金项目:广西自然科学基金资助项目（编号：桂科自0640060） |
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| Effect of two mechanical ventilation strategies on lung compliance and blood IL-6、IL-8 in elder patients during surgery |
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HUANG Zhong-hua,ZHU Wei-lin,QIN Dan-dan
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Department of Anesthesiology, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
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| Abstract: |
| ［Abstract］ 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 ASAⅠ～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 cmH2O； group B(VT 12 ml/kg PBW).Pressure controlled ventilation was performed after tracheal intubation, PETCO2 was maintained at normal range through respiratory rate adjusted（RR）.HR,MAP,SpO2,PET CO2,CL were monitored continuously and recorded at 5 min(T0),30 min(T1),1 h(T2),3 h(T3) after tracheal intubation；the serum levels of the interleukins IL-6 and IL-8 were monitored at 5min and 3 h after ventilation strategies.Results There were no significant differences in HR,MAP and PETCO2 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 elder 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 mechanical ventilation with low tidal volume than that in conventional ventilation with high tidal volume. |
| Key words: Ventilation Low tidal volumes Lung compliance Inflammatory factor |
