中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2015年
3期
154-158
,共5页
黄丽霞%汪国香%徐旭东%万海方%王振%陶凡
黃麗霞%汪國香%徐旭東%萬海方%王振%陶凡
황려하%왕국향%서욱동%만해방%왕진%도범
允许性高碳酸血症%单肺通气%呼吸窘迫综合征,成人%炎性因子
允許性高碳痠血癥%單肺通氣%呼吸窘迫綜閤徵,成人%炎性因子
윤허성고탄산혈증%단폐통기%호흡군박종합정,성인%염성인자
Permissive hypercapnia%One-lung ventilation%Respiratory distress syndrome,adult%Inflammatory factor
目的 研究允许性高碳酸血症(PHC)对肺结核患者单肺通气(OLV)时炎性因子的影响.方法 从2010年10月至2013年10月杭州市红十字会医院收治的择期肺结核胸科手术患者中选择60例患者,按随机数字表法将其分为3组,其中动脉血二氧化碳分压(PaCO2)维持在35～45 mmHg(1 mmHg=0.133 kPa)的20例患者作为对照组,PaCO2维持在50～55mmHg的20例患者作为高碳酸血症低组,PaCO2维持在56～60 mmHg的20例患者作为高碳酸血症高组.测定所有患者麻醉诱导后仰卧位双肺通气(T1)、侧卧位OLV后15 min(T2)、OLV后30 min(T3)、术后2 h(T4)、术后6 h(T5)血清中IL-6、IL-8的水平.计量资料比较采用t检验.结果 与T1时间点比较,IL-6均在T3时间点开始升高,差异有统计学意义[对照组:(4.94±1.60) pg/mL比(3.32±1.34)pg/mL,t=3.47,P＜0.01;高碳酸血症低组:(5.38±1.42)pg/mL比(3.69±1.35) pg/mL,t=3.86,P＜0.01;高碳酸血症高组:(5.57±1.34) pg/mL比(3.50±1.22) pg/mL,t=5.11,P＜0.01];IL-8则在T4时间点显著升高,差异有统计学意义[对照组:(342.09±56.12)pg/mL比(194.58±30.07) pg/mL,t=10.36,P＜0.01;高碳酸血症低组:(349.48±43.49) pg/mL比(193.16±26.27) pg/mL,t=13.80,P＜0.01;高碳酸血症高组:(351.55±38.13) pg/mL比(186.02±21.08) pg/mL,t=16.99,P＜0.01].T4、T5时间点,高碳酸血症组(包括低组和高组)IL-6显著低于对照组[T4:(38.49±9.70)、(43.41±9.01) pg/mL比(62.35±7.83) pg/mL,t值分别为8.56、7.10,均P＜0.01;T5:(56.39±7.47)、(54.77±7.12) pg/mL比(107.32±13.97)pg/mL,t值分别为-14.38、-14.99,均P＜0.01].结论 肺结核患者OLV期间及术后IL-6、IL-8水平均升高,采用小潮气量PHC策略可显著减少IL-6释放,减轻肺结核手术患者肺炎性反应.
目的 研究允許性高碳痠血癥(PHC)對肺結覈患者單肺通氣(OLV)時炎性因子的影響.方法 從2010年10月至2013年10月杭州市紅十字會醫院收治的擇期肺結覈胸科手術患者中選擇60例患者,按隨機數字錶法將其分為3組,其中動脈血二氧化碳分壓(PaCO2)維持在35～45 mmHg(1 mmHg=0.133 kPa)的20例患者作為對照組,PaCO2維持在50～55mmHg的20例患者作為高碳痠血癥低組,PaCO2維持在56～60 mmHg的20例患者作為高碳痠血癥高組.測定所有患者痳醉誘導後仰臥位雙肺通氣(T1)、側臥位OLV後15 min(T2)、OLV後30 min(T3)、術後2 h(T4)、術後6 h(T5)血清中IL-6、IL-8的水平.計量資料比較採用t檢驗.結果 與T1時間點比較,IL-6均在T3時間點開始升高,差異有統計學意義[對照組:(4.94±1.60) pg/mL比(3.32±1.34)pg/mL,t=3.47,P＜0.01;高碳痠血癥低組:(5.38±1.42)pg/mL比(3.69±1.35) pg/mL,t=3.86,P＜0.01;高碳痠血癥高組:(5.57±1.34) pg/mL比(3.50±1.22) pg/mL,t=5.11,P＜0.01];IL-8則在T4時間點顯著升高,差異有統計學意義[對照組:(342.09±56.12)pg/mL比(194.58±30.07) pg/mL,t=10.36,P＜0.01;高碳痠血癥低組:(349.48±43.49) pg/mL比(193.16±26.27) pg/mL,t=13.80,P＜0.01;高碳痠血癥高組:(351.55±38.13) pg/mL比(186.02±21.08) pg/mL,t=16.99,P＜0.01].T4、T5時間點,高碳痠血癥組(包括低組和高組)IL-6顯著低于對照組[T4:(38.49±9.70)、(43.41±9.01) pg/mL比(62.35±7.83) pg/mL,t值分彆為8.56、7.10,均P＜0.01;T5:(56.39±7.47)、(54.77±7.12) pg/mL比(107.32±13.97)pg/mL,t值分彆為-14.38、-14.99,均P＜0.01].結論 肺結覈患者OLV期間及術後IL-6、IL-8水平均升高,採用小潮氣量PHC策略可顯著減少IL-6釋放,減輕肺結覈手術患者肺炎性反應.
목적 연구윤허성고탄산혈증(PHC)대폐결핵환자단폐통기(OLV)시염성인자적영향.방법 종2010년10월지2013년10월항주시홍십자회의원수치적택기폐결핵흉과수술환자중선택60례환자,안수궤수자표법장기분위3조,기중동맥혈이양화탄분압(PaCO2)유지재35～45 mmHg(1 mmHg=0.133 kPa)적20례환자작위대조조,PaCO2유지재50～55mmHg적20례환자작위고탄산혈증저조,PaCO2유지재56～60 mmHg적20례환자작위고탄산혈증고조.측정소유환자마취유도후앙와위쌍폐통기(T1)、측와위OLV후15 min(T2)、OLV후30 min(T3)、술후2 h(T4)、술후6 h(T5)혈청중IL-6、IL-8적수평.계량자료비교채용t검험.결과 여T1시간점비교,IL-6균재T3시간점개시승고,차이유통계학의의[대조조:(4.94±1.60) pg/mL비(3.32±1.34)pg/mL,t=3.47,P＜0.01;고탄산혈증저조:(5.38±1.42)pg/mL비(3.69±1.35) pg/mL,t=3.86,P＜0.01;고탄산혈증고조:(5.57±1.34) pg/mL비(3.50±1.22) pg/mL,t=5.11,P＜0.01];IL-8칙재T4시간점현저승고,차이유통계학의의[대조조:(342.09±56.12)pg/mL비(194.58±30.07) pg/mL,t=10.36,P＜0.01;고탄산혈증저조:(349.48±43.49) pg/mL비(193.16±26.27) pg/mL,t=13.80,P＜0.01;고탄산혈증고조:(351.55±38.13) pg/mL비(186.02±21.08) pg/mL,t=16.99,P＜0.01].T4、T5시간점,고탄산혈증조(포괄저조화고조)IL-6현저저우대조조[T4:(38.49±9.70)、(43.41±9.01) pg/mL비(62.35±7.83) pg/mL,t치분별위8.56、7.10,균P＜0.01;T5:(56.39±7.47)、(54.77±7.12) pg/mL비(107.32±13.97)pg/mL,t치분별위-14.38、-14.99,균P＜0.01].결론 폐결핵환자OLV기간급술후IL-6、IL-8수평균승고,채용소조기량PHC책략가현저감소IL-6석방,감경폐결핵수술환자폐염성반응.
Objective To study the effects of permissive hypercapnia (PHC) on inflammatory factors of pulmonary tuberculosis patients with one-lung ventilation (OLV).Methods Sixty pulmonary tuberculosis patients with selective thoracic operation who were hospitalized at Hangzhou Red-cross Hospital from October 2010 to October 2013 were randomized into three groups by means of random digits table.Twenty patients were enrolled as control group whose arterial partial pressure of carbon dioxide (PaCO2) was maintained at 35-45 mmHg (1 mmHg=0.133 kPa),20 patients as lower PHC group whose PaCO2 were maintained at 50-55 mmHg,and 20 patients as higher PHC group whose PaCO2 were maintained at 56-60 mmHg.The concentrations of serum interleukin (IL)-6 and IL-8 were measured at the time when the patients were in supine position by two-lung ventilation after induction of anesthesia (T1),15 minutes (T2) and 30 minutes after OLV (T3) in lateral position,two hours (T4) and 6 hours after operation (T5).Quantitative data were analyzed by t-test.Results IL-6 at T3 time point in the three groups increased significantly compared with T1 time point (control group:[4.94± 1.60] pg/mL vs [3.32±1.34] pg/mL,t=3.47,P＜0.01; lower PHC group:[5.38±1.42] pg/mL vs [3.69±1.35] pg/mL,t=3.86,P＜0.01; higher PHC group:[5.57±± 1.34] pg/mL vs [3.50 ± 1.22] pg/mL,t=5.11,P＜0.01).IL-8 at T4 time point increased significantly compared with T1 time point (control group:[342.09±56.12] pg/mL vs [194.58 ± 30.07] pg/mL,t =10.36,P＜0.01; lower PHC group:[349.48±43.49] pg/mL vs [193.16±26.27] pg/mL,t=13.80,P＜0.01; higher PHC group:[351.55±38.13] pg/mL vs [186.02±21.08] pg/mL,t=16.99,P＜0.01).IL-6 at the T4 and T5 time points in both lower PHC group and higher PHC group decreased significantly compared with control groupatthe same time points (T4..[38.49± 9.70] and [43.41± 9.01] pg/mL vs [62.35±7.83] pg/mL,t=8.56 and 7.10,both P＜0.01; T5:[56.39±7.47] and [54.77±7.12] pg/mL vs [107.32± 13.97] pg/mL,t=-14.38 and-14.99,both P＜0.01].Conclusions The serum IL-6 and IL-8 levels in pulmonary tuberculosis patients with OLV increase after selective thoracic operation.PHC through low tidal volume could decrease the release of IL-6 and attenuate the pulmonary inflammatory injury in the tuberculosis patients with operation.
