摘要
目的评价肺保护性通气对不同终末期肝病模型(MELD)评分肝移植手术患者的肺保护作用。方法选择终末期肝病患者80例,ASAⅡ~Ⅳ级,并根据MELD分值及随机数字表法分为4组:MELD≤15分+常规机械通气组(Ⅰc组)、MELD≤15分+肺保护性通气组(Ⅰp组)、MELD>15分+常规机械通气组(Ⅱc组)和MELD>15分+肺保护性通气组(Ⅱp组),每组20例。所有患者分别于切皮前(T_1)、无肝前期3 h(T_2)、无肝期30 min(T_3)、新肝期2 h(T_4)及新肝期4 h(T_5)、术后2 h(T_6)、拔管前(T_7)及术后1 d(T_8)时,检测血清克拉拉细胞分泌蛋白16(clara cell secretory protein,CC16)、肿瘤坏死因子-α(T_NF-α)和白介素-8(IL-8)水平。记录患者术后清醒时间、拔管时间、ICU停留时间及术后1周内急性肺损伤发生情况。结果不同MELD分值两组间比较,MELD>15分患者输血量增多,手术时间延长(P<0.05),氧合指数降低,术后急性肺损伤发生率较高,气管拔管时间及ICU停留时间延长(P<0.01),T_2~T_8时血清CC16、T_NF-α、IL-8浓度升高(P<0.05或P<0.01);不同通气方式两组间比较,保护性通气组的气管拔管时间分别为(7.2±1.5)h和(12.1±5.6)h,短于常规机械通气组(P<0.05)。结论肺保护性通气能改善肝移植手术患者(尤其是MELD评分>15分)的氧合指数,降低术后急性肺损伤的发生率,缩短拔管时间,有利于改善肺功能。
Objective To assess the influence of lung protective mechanical ventilation strategy on patients who had different MELD scores during liver transplantation surgery. Methods Eighty patients of both sexes,of American Society of Anesthesiologists physical status Ⅱor Ⅳ,and scheduled for liver transplantation under general anesthesia,were divided into four groups according to the evaluation by MELD scoring system and mechanical ventilation mode： MELD ≤ 15 with conventional mechanical ventilation group（ group Ⅰc）,MELD≤15 with protective mechanical ventilation group（ group Ⅰp）,MELD 15 with conventional mechanical ventilation group（ group Ⅱc） and MELD 15 with protective mechanical ventilation group（ group Ⅱp）. Blood samples from the radial artery,plasma markers of lung injury and inflammatory mediators were collected at 8 time points： before operation（ T1）,3 h into the preanhepatic stage（ T2）,30 min into the anhepatic stage（ T3）,2 h（ T4）,4 h into the neohepatic stage（ T5）,2 h after operation（ T6）,before extubation（ T7） and 1 d after operation（ T8）. Plasma markers of lung injury,which were clara cell secretory protein 16（ CC16） and inflammatory mediators,such as TNF-α and IL-8,were monitored. Moreover,the oxygenation index（ OI）,time eyes were opened,time of tracheal extubation,lenghth of ICU stay and acute lung injury incidence within 1 week were recorded. Results Patients with MELD scores above 15 showed a larger blood transfusion volume,a longer duration of surgery and a lower OI（ P〈0. 05 or P〈0. 01）. A higher incidence of acute lung injury,an earlier tracheal extubation and a longer stay of ICU were found（ P〈0. 01）. In addition,levels of CC16,TNF-α and IL-8 were higher（ P〈0. 05 or P〈0. 01） in these groups. Among patients who had performed the lung protective mechanical ventilation strategy,the tracheal extubation time was（ 7. 2 ± 1. 5） and（ 12. 1 ± 5. 6） h respectively,which was earlier than that of patients in
作者
李占军
张迁龙
陈晓阳
董兰
LI Zhanjun;ZHANG Qianlong;CHEN Xiaoyang;DONG Lan.(Department of Anesthesiology, General Hospital of Chinese people＇ s Police, Beijing 100039, China)
出处
《武警医学》
CAS
2018年第4期388-392,共5页
Medical Journal of the Chinese People's Armed Police Force
基金
国家高技术研究发展计划(863计划)(2012AA021006)
关键词
肺保护性通气
终末期肝病模型评分
肝移植
急性肺损伤
肺损伤血清生物标志物
lung protective mechanical ventilation strategy
model for end-stage liver disease
liver transplatation
acute lung inju-ry
plasma markers of lung injury
