CAJ | 학술논문

目的观察大潮气量低呼吸终末压力(H.Vt/L-PEEP)和低潮气量高呼吸终末压力(LwH_PEEP)两种不同机械通气方式对冠状动脉旁路移植术后机体炎症介质IL--6和IL-8浓度的影响,寻找冠状动脉旁路移植术后更为合理的机械通气方式.方法 40例择期行冠状动脉旁路移植术者在相同的麻醉和体外循环条件下,按大潮气量低呼吸终末压力和低潮气量高呼吸终末压力机械通气方式随机分为两组,分别于开胸前(TO)、体外循环结束(T1)、体外循环停止机械通气6 h(r12)采集支气管灌洗液和中心静脉血样本,观察3个时点两组Ⅱ,6及IL-8在支气管灌洗液和血浆中的浓度变化.结果两组支气管灌洗液及血浆炎症介质IL-6、IL-8浓度在Tl时显著增高.机械通气6 h后(12)L-VdH.PEEP组支气管灌洗液及血浆Ⅱ,6、IL-8浓度无明显改变,而H-VdL-PEEP组则显著升高(P<O.05).结论低潮气量高呼吸终末压力(L-Vt/H.PEEP)的机械通气方式,未进一步提高术后体内炎症介质的浓度,对病人起到了保护性作用,病人术后带管时间明显缩短.与大潮气量低呼吸终末压力(H.Vt/L-PEEP)的机械通气方式相比,是体外循环下冠状动脉旁路移植术后更为合理的机械通气方式.
목적 관찰대조기량저호흡종말압력(H.Vt/L-PEEP)화저조기량고호흡종말압력(LwH_PEEP)량충불동궤계통기방식대관상동맥방로이식술후궤체염증개질IL--6화IL-8농도적영향,심조관상동맥방로이식술후경위합리적궤계통기방식.방법 40례택기행관상동맥방로이식술자재상동적마취화체외순배조건하,안대조기량저호흡종말압력화저조기량고호흡종말압력궤계통기방식수궤분위량조,분별우개흉전(TO)、체외순배결속(T1)、체외순배정지궤계통기6 h(r12)채집지기관관세액화중심정맥혈양본,관찰3개시점량조Ⅱ,6급IL-8재지기관관세액화혈장중적농도변화.결과 량조지기관관세액급혈장염증개질IL-6、IL-8농도재Tl시현저증고.궤계통기6 h후(12)L-VdH.PEEP조지기관관세액급혈장Ⅱ,6、IL-8농도무명현개변,이H-VdL-PEEP조칙현저승고(P<O.05).결론 저조기량고호흡종말압력(L-Vt/H.PEEP)적궤계통기방식,미진일보제고술후체내염증개질적농도,대병인기도료보호성작용,병인술후대관시간명현축단.여대조기량저호흡종말압력(H.Vt/L-PEEP)적궤계통기방식상비,시체외순배하관상동맥방로이식술후경위합리적궤계통기방식.
Objective Not only the systemic inflammation and acute organ injury are all caused by inflammatory mediators but also the intension of them are close relate the levds of inflammatory mediators.Through observation on the content of Interleukin 6 Interloakin 8 in two diffenmt medmenl ventilation groups(high tidal volunles/low positive end-expiratory pressure,low tidal Volunes/ high positive end-expiratory pressure)to find which is the better ventilatory method to the patients undergoing coronary artery bypass grafting.Methods Forty patients undergoing elective coronary artery bypass were randomized to be ventilated after cardiaopulmonary bypass disconnection with high tidal volumes/low poaitive end-expirstory pressure(10-12 ml/kg and 2-4 emH2O) or low tidal vol-umes/high positive end-expiratory pressure(6-8 ml/kg and 8-10 cmH2O).Intedeukin 6 and Intedeukin 8 levels were measured in the bronchoalveolar lavage fluid and plasma.Samples were taken before sternotmy(TO),immeditately after cardiaopulmonary bypass seperation(T1),and after 6 hours of medlmieal ventilation(T2).Results Interleukin 6 and Intedeukin 8 levels in the bronchoalveo-lariavagefluid and plm aignitleamlyincreased atTI in both groups but further increased signiiieantly at T2 onlyin patients ventilat-ed with tidal volumes/low positive end-expiratory pressure.Conclusion Ventilation with low tidal volumes/high positive erd-ex-piratory pressure not increased the level of inflammatory mediators,mediators,protects the systemic function to patients,avoids acute organ inju-ry,is the better ventilatory method for patients undergoing cotonary artery bypass grafting from cardiaopulmonary bypass.