CAJ | 학술논문

目的评价选择性肺叶通气对肺功能不全患者开胸术中肺内分流和炎性反应的影响.方法择期行食管癌根治术患者34例,年龄64～79岁,体重50～85 kg,ASA分级Ⅱ或Ⅲ级,合并中重度肺功能不全,采用随机数字表法,将其随机分为2组(n=17):单肺通气组(A组)和选择性肺叶通气组(B组).A组患者使用支气管堵塞器堵塞主支气管实施单肺通气；B组患者使用支气管堵塞器堵塞肺叶支气管,实施选择性肺叶通气.于麻醉诱导前(To)、侧卧位双肺通气30 min (T1)、单肺通气或选择性肺叶通气60 min(T2)和术毕(T3)时,记录气道平台压(Pplat)和气道峰压(Ppeak)；采集桡动脉、中心静脉血样,进行血气分析,计算肺内分流率(Qs/Qt),采用ELISA法测定血浆TNF-α、IL-6和IL-8的浓度.结果 A组3例患者(18％)发生低氧血症,B组均未发生低氧血症,A组低氧血症发生率高于B组(P＜0.05).与A组比较,B组T1 -3时Pplat、Ppeak降低,T2时Qs/Qt降低,T2.3时TNF-α、IL-6和IL-8浓度降低(P＜0.05).结论中重度肺功能不全患者开胸术中,实施选择性肺叶通气可降低肺内分流,减轻炎性反应,有助于减轻机械通气性肺损伤.
목적 평개선택성폐협통기대폐공능불전환자개흉술중폐내분류화염성반응적영향.방법 택기행식관암근치술환자34례,년령64～79세,체중50～85 kg,ASA분급Ⅱ혹Ⅲ급,합병중중도폐공능불전,채용수궤수자표법,장기수궤분위2조(n=17):단폐통기조(A조)화선택성폐협통기조(B조).A조환자사용지기관도새기도새주지기관실시단폐통기；B조환자사용지기관도새기도새폐협지기관,실시선택성폐협통기.우마취유도전(To)、측와위쌍폐통기30 min (T1)、단폐통기혹선택성폐협통기60 min(T2)화술필(T3)시,기록기도평태압(Pplat)화기도봉압(Ppeak)；채집뇨동맥、중심정맥혈양,진행혈기분석,계산폐내분류솔(Qs/Qt),채용ELISA법측정혈장TNF-α、IL-6화IL-8적농도.결과 A조3례환자(18％)발생저양혈증,B조균미발생저양혈증,A조저양혈증발생솔고우B조(P＜0.05).여A조비교,B조T1 -3시Pplat、Ppeak강저,T2시Qs/Qt강저,T2.3시TNF-α、IL-6화IL-8농도강저(P＜0.05).결론 중중도폐공능불전환자개흉술중,실시선택성폐협통기가강저폐내분류,감경염성반응,유조우감경궤계통기성폐손상.
Objective To investigate the effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy.Methods Thirty-four ASA Ⅱ or Ⅲ patients,aged 64-79 yr,weighing 50-85 kg,with moderate and severe impaired pulmonary function,scheduled for esophageal cancer radical correction,were randomly divided into 2 groups( n =17 each): one-lung ventilation group (group A) and selective lobar ventilation group (group B).In group A,endobronchial blocker tube was used to obstruct bronchus principalis and practice one-lung ventilation.In group B,endobronchial blocker tube was used to obstruct bronchi lobares and practice selective lobar ventilation.The blood samples were taken from arteria radialis and internal jugular vein for blood gas analysis and determination of the plasma concentrations of TNF-α,IL-6 and IL-8 by ELISA before anesthesia induction(T0 ),at 30 min following two-lung ventilation at lateral position (T1),at 60 min following one-lung ventilation or selective lobar ventilation (T2) and at the end of surgery (T3).Ppeak and Plat.were recordeded at the same time.Results The incidence of hypoxemia was significantly lower in group B (0) than in group A(18％ )( P ＜0.05).Compared with group A,Pplat and Ppeak at T1-3,Qs/Qt at T2,TNF-α,IL-6 and IL-8 concentrations at T2-3 were significantly decreased in group B( P ＜ 0.05 ).Conclusion The selective lobar ventilation can reduce intrapulmonary shunt,inhibit inflammatory response to help lessen mechanical ventilation related lung injury during thoracotomy in patients with pulmonary function.