CAJ | 학술논문

目的探讨术中机械通气对Ⅱ型糖尿病患者肺换气功能的影响.方法择期全麻下行全胃切除术的Ⅱ型糖尿病患者30例和非糖尿患者15例,ASA分级Ⅰ或Ⅱ级,年龄46～64岁,体重47～78 kg,非糖尿病患者为对照组(A组,n=15),30例糖尿病患者按照术前糖化血红蛋白(HbA1C)水平分为2组(n=15):B组(HbA1C与Hb比值6.6%～10.4%)和C组(HbA1C与Hb比值＞10.4%).麻醉诱导后气管插管,行机械通气,Vr8 ml/kg,RR 12～14次/min,吸呼比1∶2,吸入纯氧,维持PETCO230～35 mm Hg.分别于麻醉前(T0)、机械通气30 min(T1)、60 min(T2)、90 min(T3)、120 min(T4)时采集桡动脉血样,进行血气分析,计算肺泡-动脉血氧分压差(PA-aDO2);同时测定血浆SOD、MDA、TNF-α、IL-6及IL-10的水平.结果与A组比较,B组和C组T1-4时PA-aDO2、血浆MDA、TNF-α、IL-6和IL-10的浓度升高,血浆SOD活性降低(P＜0.05).与B组比较,C组T1-4时PA-aDO2、血浆MDA、TNF-α、IL-6和IL10的浓度升高,血浆SOD活性降低(P＜0.05).结论术中机械通气可使Ⅱ型糖尿病患者肺换气功能下降,且与病情有关,其机制与机械通气诱发炎性反应有关.
목적 탐토술중궤계통기대Ⅱ형당뇨병환자폐환기공능적영향.방법 택기전마하행전위절제술적Ⅱ형당뇨병환자30례화비당뇨환자15례,ASA분급Ⅰ혹Ⅱ급,년령46～64세,체중47～78 kg,비당뇨병환자위대조조(A조,n=15),30례당뇨병환자안조술전당화혈홍단백(HbA1C)수평분위2조(n=15):B조(HbA1C여Hb비치6.6%～10.4%)화C조(HbA1C여Hb비치＞10.4%).마취유도후기관삽관,행궤계통기,Vr8 ml/kg,RR 12～14차/min,흡호비1∶2,흡입순양,유지PETCO230～35 mm Hg.분별우마취전(T0)、궤계통기30 min(T1)、60 min(T2)、90 min(T3)、120 min(T4)시채집뇨동맥혈양,진행혈기분석,계산폐포-동맥혈양분압차(PA-aDO2);동시측정혈장SOD、MDA、TNF-α、IL-6급IL-10적수평.결과 여A조비교,B조화C조T1-4시PA-aDO2、혈장MDA、TNF-α、IL-6화IL-10적농도승고,혈장SOD활성강저(P＜0.05).여B조비교,C조T1-4시PA-aDO2、혈장MDA、TNF-α、IL-6화IL10적농도승고,혈장SOD활성강저(P＜0.05).결론 술중궤계통기가사Ⅱ형당뇨병환자폐환기공능하강,차여병정유관,기궤제여궤계통기유발염성반응유관.
Objective To evaluate the effect of intraoperative mechanical ventilation on alveolar gas exchange in patients with type 2 diabetes mellitus.Methods Thirty ASA Ⅰor Ⅱpatients with type 2 diabetes mellitus aged 46-64 yr weighing 47-78 kg undergoing total gastrectomy under general anesthesia were divided into 2groups according to preoperative glycolated hemoglobin level(HbA1c)(n=15 each):group B HbA1c/Hb=6.6%-10.4%and group C HbA1c/Hb＞10.4%.Another 15 non-diabetic patients with comparable demographic data were included in this study as control group(group A).Radial artery and right internal jugular vein were cannulated.The patients were intubated after induction of anesthesia and mechanically ventilated(VT 8 ml/kg,RR 12-lected from artery before induction of anesthesia(To,baseline)and at 30,60,90 and 120 min of mechanical ventilation(T1-4)for blood gas analysis and determination of plasma SOD activity and MDA,'TNF-α,IL-6,IL-10 concentrations.PA-aDO2 was calculated.Results PA-aDO2 was significantly increased during mechanical ventilation at T1-4 as compared with the baseline at T0 in diabetic patients and were significantly higher than in non-diabetic patients.The plasma SOD activity was significantly decreased at T1-4 as compared with the baseline at T0 in diabetic patients and was significantly lower than in non-diabetic patients.While the plasma MDA,TNF-α,IL-6 and IL-10concentrations were significantly increased at T1-4 compared with the baseline at T0 in diabetic patients and were significantly higher than in non-diabetic patients.The PA-aDO2,plasma MDA,TNF-α,IL-6 and IL-10 concentrations were significantly higher and plasma SOD activity lower in gorup C than in group B.Conclusion Intraoperative mechanical ventilation can decrease alveolar gas exchange by inducing inflammatory response in patients with type 2 diabetes mellitus.The changes are correlated with severity of diabetes.