| 摘要: |
| ［摘要］ 目的 观察腹腔镜结直肠癌手术中不同通气策略对患者机械功（mechanical power，MP）及炎症因子水平的影响。方法 选择2021年5月至2021年11月在广州市红十字会医院接受腹腔镜下结直肠癌手术的患者60例，采用随机数字表法将其分为常规通气组（V组）和肺保护通气组（P组），每组30例。V组：潮气量（VT）=9 ml/kg，呼吸末正压（PEEP）=0 cmH2O。P组：VT=7 ml/kg，PEEP=5 cmH2O。于气管插管后5 min（T1）、建立气腹后10 min（T2）、60 min（T3）和气腹消失后10 min（T4）时间点，记录气道峰压（Ppeak）、气道平台压（Pplat）、肺动态顺应性（Cdyn）并计算MP。于T1、T2、T3、进入麻醉后监测治疗室（PACU）时采集动脉血行血气分析，记录血气酸碱度（pH值）、二氧化碳分压（PaCO2）、氧分压（PaO2）并计算氧合指数（OI）和肺泡-动脉氧分压差（PA-aO2）。于T1、T3和术毕测定血清中肺Clara细胞分泌蛋白（CC-16）、白细胞介素-6（IL-6）和中性粒细胞弹性蛋白酶（NE）水平。结果 两组MP在T2～T4时间点呈升高趋势，血清CC-16、IL-6和NE水平在T3和术毕均较T1时间点显著升高（P<0.05）。在T2、T3时间点，P组MP水平低于V组，差异有统计学意义（P<0.05）。在术毕即刻，P组血清CC-16、IL-6水平均显著低于V组（P<0.05）。气腹期间总MP大小与血清CC-16、IL-6和NE变化水平呈正相关（P<0.05）。结论 肺保护性通气策略的保护机制可能与较低的MP有关。 |
| 关键词: 机械功 呼吸机相关性肺损伤 腹腔镜 炎症因子 |
| DOI：10.3969/j.issn.1674-3806.2023.02.09 |
| 分类号:R 61 |
| 基金项目:广州市科技计划项目（编号：202103000022）；广州市卫生健康科技项目（编号：20221A011020） |
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| Effects of different ventilation strategies on mechanical power and inflammatory factor levels in patients undergoing laparoscopic colorectal cancer surgery |
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WANG Zuo-huan, WANG Lin, CAO Yang
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College of Anesthesiology, Guizhou Medical University, Guiyang 550004, China; Department of Anesthesiology, Guangzhou Red Cross Hospital, Guangdong 510220, China
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| Abstract: |
| ［Abstract］ Objective To observe the effects of different ventilation strategies on mechanical power(MP) and inflammatory factor levels in patients undergoing laparoscopic colorectal cancer surgery. Methods Sixty patients who underwent laparoscopic colorectal cancer surgery in Guangzhou Red Cross Hospital from May 2021 to November 2021 were selected and divided into conventional ventilation group(group V) and lung protective ventilation group(group P) by random number table method, with 30 cases in each group. Group V: tidal volume(VT)=9 ml/kg, positive end expiratory pressure(PEEP)=0 cmH2O; Group P: VT=7 ml/kg, PEEP=5 cmH2O. Peak airway pressure(Ppeak), airway plateau pressure(Pplat) and pulmonary dynamic compliance(Cdyn) were recorded 5 minutes after endotracheal intubation(T1), 10 minutes(T2) and 60 minutes(T3) after establishment of CO2 pneumoperitoneum, and 10 minutes after pneumoperitoneum disappeared(T4), and MP was calculated. Radial artery blood were collected for blood gas analysis at T1, T2, T3 and when the patients entered the postanesthesia care unit(PACU), and pH, arterial partial pressure of carbon dioxide(PaCO2) and arterial partial pressure of oxygen(PaO2) were recorded, and oxygenation index(OI) and alveolar-arterial oxygen differential(PA-aO2) were calculated. The levels of lung Clara cell secretory protein(CC-16), interleukin-6(IL-6) and neutrophil elastase(NE) in serum were detected at T1, T3 and immediately after operation, respectively. Results MP showed an increasing trend in both groups at the time points from T2 to T4, and the serum levels of CC-16, IL-6 and NE were significantly increased at T3 and after surgery compared with those at T1(P<0.05). At the time points of T2 and T3, the MP level in group P was lower than that in group V, and the difference was statistically significant(P<0.05). The serum levels of CC-16 and IL-6 in group P were significantly lower than those in group V immediately after operation(P<0.05). The total MP size was positively correlated with the changes of the serum CC-16, IL-6 and NE levels during pneumoperitoneum(P<0.05). Conclusion The protective mechanism of lung protective ventilation strategy may be related to lower MP. |
| Key words: Mechanical power(MP) Ventilator-induced lung injury Laparoscope Inflammatory cytokine |
