中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
5期
683-685
,共3页
杨沛%张学政%杨涛%何国栋%蓝仲岳%徐旭仲%金烈烈
楊沛%張學政%楊濤%何國棟%藍仲嶽%徐旭仲%金烈烈
양패%장학정%양도%하국동%람중악%서욱중%금렬렬
机械通气%低潮气量%炎性因子%老年患者
機械通氣%低潮氣量%炎性因子%老年患者
궤계통기%저조기량%염성인자%노년환자
Ventilation%Low tidal volumes%Inflammatory factor%Elderly patients
目的 探讨不同通气策略对老年患者腹部手术支气管肺泡灌洗液(BALF)中肿瘤坏死因子α(TNF-α)和白细胞介素8(IL-8)浓度的影响.方法 选择温州医科大学附属第一医院择期行腹部择期手术的老年患者90例,根据机械通气方式不同,完全随机分为Ⅰ组(常规潮气量组)、Ⅱ组(低潮气量组)和Ⅲ组(低潮气量±呼气末正压),每组30例于插管后3 min、麻醉机械通气3h收集BALF,检测BALF中TNF-α、IL-8水平.结果 3组患者插管后3h的TNF-α、IL-8与插管后3 min比较,差异均有统计学意义[Ⅰ组:(62±4) μg/L比(24±5) μg/L,(97±5)μg/L比(42±5)μg/L;Ⅱ组:(38±4)μg/L比(23±3)μg/L,(61±4) μg/L比(44±5)μg/L;Ⅲ组:(39±4)μg/L比(24 ±4) μg/L,(69±5) μg/L比(4l±6)μg/L](均P＜0.05).Ⅱ组和Ⅲ组插管后3 h的TNF-α、IL-8低于Ⅰ组,差异均有统计学意义(均P＜0.05)结论 在老年患者腹部手术中,低潮气量、低潮气量加小呼气末正压、常规潮气量均可引起老年患者BALF中TNF-α和IL-8水平升高,但常规潮气量更为显著.
目的 探討不同通氣策略對老年患者腹部手術支氣管肺泡灌洗液(BALF)中腫瘤壞死因子α(TNF-α)和白細胞介素8(IL-8)濃度的影響.方法 選擇溫州醫科大學附屬第一醫院擇期行腹部擇期手術的老年患者90例,根據機械通氣方式不同,完全隨機分為Ⅰ組(常規潮氣量組)、Ⅱ組(低潮氣量組)和Ⅲ組(低潮氣量±呼氣末正壓),每組30例于插管後3 min、痳醉機械通氣3h收集BALF,檢測BALF中TNF-α、IL-8水平.結果 3組患者插管後3h的TNF-α、IL-8與插管後3 min比較,差異均有統計學意義[Ⅰ組:(62±4) μg/L比(24±5) μg/L,(97±5)μg/L比(42±5)μg/L;Ⅱ組:(38±4)μg/L比(23±3)μg/L,(61±4) μg/L比(44±5)μg/L;Ⅲ組:(39±4)μg/L比(24 ±4) μg/L,(69±5) μg/L比(4l±6)μg/L](均P＜0.05).Ⅱ組和Ⅲ組插管後3 h的TNF-α、IL-8低于Ⅰ組,差異均有統計學意義(均P＜0.05)結論 在老年患者腹部手術中,低潮氣量、低潮氣量加小呼氣末正壓、常規潮氣量均可引起老年患者BALF中TNF-α和IL-8水平升高,但常規潮氣量更為顯著.
목적 탐토불동통기책략대노년환자복부수술지기관폐포관세액(BALF)중종류배사인자α(TNF-α)화백세포개소8(IL-8)농도적영향.방법 선택온주의과대학부속제일의원택기행복부택기수술적노년환자90례,근거궤계통기방식불동,완전수궤분위Ⅰ조(상규조기량조)、Ⅱ조(저조기량조)화Ⅲ조(저조기량±호기말정압),매조30례우삽관후3 min、마취궤계통기3h수집BALF,검측BALF중TNF-α、IL-8수평.결과 3조환자삽관후3h적TNF-α、IL-8여삽관후3 min비교,차이균유통계학의의[Ⅰ조:(62±4) μg/L비(24±5) μg/L,(97±5)μg/L비(42±5)μg/L;Ⅱ조:(38±4)μg/L비(23±3)μg/L,(61±4) μg/L비(44±5)μg/L;Ⅲ조:(39±4)μg/L비(24 ±4) μg/L,(69±5) μg/L비(4l±6)μg/L](균P＜0.05).Ⅱ조화Ⅲ조삽관후3 h적TNF-α、IL-8저우Ⅰ조,차이균유통계학의의(균P＜0.05)결론 재노년환자복부수술중,저조기량、저조기량가소호기말정압、상규조기량균가인기노년환자BALF중TNF-α화IL-8수평승고,단상규조기량경위현저.
Objective To investigate the effect of three ventilation strategies on tumor necrosis factor α (TNF-α) and interleukin 8 (IL-8) of bronchial veolar lavage fluid (BALF) in elder patients during abdominal surgery.Methods Ninety elder patients with abdominal surgery of First Affiliated Hospital of the Wenzhou medical university were seleeted,and divided into group Ⅰ (conventional tidal volume group),group Ⅱ (low water volume group) and group Ⅲ [low water volume ± positive and expiratory pressure (PEEP)],each group had 30 cases.BALF of 3 groups were selected after 3 min of intubation and anesthesia mechanical ventilation for 3 h,and TNF-α,IL-8 of BALF were detected.Results There were significant differences on TNF-α,1L-8 of 3 groups between anesthesia mechanical ventilation for 3 h and after 3 min of intubation (P ＜ 0.05) [group Ⅰ:(62 ± 4) μg/L vs (24 ±5)μg/L,(97 ±5)μg/L vs (42 ±5) μg/L; group Ⅱ:(38 ±4)μg/L vs (23 ±3)μg/L,(61 ±4)μg/L vs (44 ±5)μg/L;groupⅢ:(39 ±4) μg/L vs (24 ±4) μg/L,(69 ±5) μg/L vs (41 ±6)μg/L].TNF-α,IL-8 of group Ⅱ and group Ⅲ after anesthesia mechanical ventilation for 3 h were lower than that of group Ⅰ,there were significant differences (P ＜0.05).Conclusion For elder patients during abdominal surgery,three mechanical ventilation strategies can increase the levels of BALF TNF-α and IL-8,but these change are less in ventilation with low tidal volume than those in conventional ventilation with high tidal volume.
