摘要
目的研究压力控制通气-容量保证通气模式(PCV-VG)对老年食管癌根治术患者肺功能和炎性反应水平影响。方法选取2017年3月至2018年2月医院行老年食管癌根治术患者112例,按照奇偶法,将纳入患者分为观察组和对照组,每组56例。观察组采用PCV-VG模式,对照组采用容量控制通气模式。观察和比较2组患者单肺通气开始前(T0)、单肺通气30 min(T1)、单肺通气60 min(T2)、双肺通气恢复30 min(T3)呼吸力学指标[气道峰值压力(Ppeak)、气道平均压力(Pmean)、肺顺应性(CL)]、血气分析指标[氧分压(PO2)、二氧化碳分压(PCO2)]、炎性因子水平[白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]和患者临床肺部感染评分(CPIS)。结果T0,2组患者Ppeak、Pmean、CL分别比较,差异无统计学意义(P> 0. 05); T1、T2,2组患者Ppeak、Pmean较T0逐渐升高,CL较T0逐渐下降,且在T1、T2、T3时,观察组Ppeak、Pmean低于对照组,CL高于对照组,差异有统计学意义(P <0. 05)。T0,2组患者PO2、PCO2分别比较,差异无统计学意义(P> 0. 05); T1、T2,2组患者PO2较T0逐渐下降,PCO2较T0逐渐升高,且在T1、T2、T3时,观察组PO2高于对照组,差异有统计学意义(P <0. 05),PCO2与对照组比较,差异无统计学意义(P> 0. 05)。T0,2组患者IL-6、IL-8、TNF-α水平分别比较,差异无统计学意义(P> 0. 05); T1、T2,2组患者IL-6、IL-8、TNF-α水平较T0逐渐升高,T3下降,且在T1、T2、T3时,观察组IL-6、IL-8、TNF-α水平均低于对照组,差异有统计学意义(P <0. 05)。T0,2组患者CPIS比较,差异无统计学意义(P> 0. 05); T1、T2,2组患者CPIS评分较T0逐渐升高,T3时下降,且在T1、T2、T3时,观察组CPIS评分低于对照组,差异有统计学意义(P <0. 05)。结论PCV-VG模式对老年食管癌根治术患者气道压力无显著升高作用,利于降低气压伤风险,减轻炎性反应,保护肺功能,从而提高根治术质量,促进患者早日康复。
Objective To investigate the effects of PCV-VG on pulmonary function and inflammatory response in elderly patients with esophageal cancer after esophageal cancer radical operation.Methods A total of 112 patients with esophageal carcinoma who underwent esophageal cancer radical operation in our hospital from March 2017 to February 2018 were enrolled in the study.According to the parity method,these patients were divided into observation group(n=56)and control group(n=56).The patients observation group were treated by PCV-VG mode,however,the patients in control group were treated by volume control ventilation mode.The respiratory mechanics indexes including Ppeak,Pmean,CL,CLO 2,PO 2,PCO 2,before single lung ventilation(T0),at 30min after single lung ventilation(T1),at 60min after single lung ventilation(T2),at 30min after lung ventilation recovery(T3),and the changes of serum levels of IL-6,IL-8 IL-8,tumor necrosis factor-α(TNF-α)as well as clinical lung infection score(CPIS)were observed and compared between the two groups.Results There were no significant differences in Ppeak,Pmean and CL at T0 between the two groups(P >0.05).The levels of Ppeak and Pmean at T1,T2 were increased in both groups,as compared with those at T0,and CL was gradually decreased,moreover,the levels of Ppeak and Pmean at T1,T2 and T3 observation group were significantly lower than those in control group,and CL was significantly higher than that in control group(P<0.05).There were no significant differences in PO 2 and PCO 2 at T0 between the two groups(P >0.05).The levels of PO 2 at T1,T2 were decreased gradually in both groups,as compared with those at T0,while PCO 2 levels were increased gradually,as compared with those at T0,moreover,the levels of PO 2 at T1,T2,T3 in observation group were significantly higher than those in control group(P<0.05).There was no significant difference in PCO 2 between the two groups(P >0.05).There were no significant differences in the serum levels of IL-6,IL-8 and TNF-αat T0 between the two groups(P >0.0
作者
张莉
王义
王莉
黄蓉
仇丽雅
任雄鹰
ZHANG Li;WANG Yi;WANG Li(Department of Anesthesiology,The First People’s Hospital of Guangyuan City,Sichuang,Guangyuan 628017,China)
出处
《河北医药》
CAS
2019年第3期365-369,共5页
Hebei Medical Journal
关键词
食管癌根治术
压力控制通气-容量保证通气模式
肺功能
炎症反应
esophageal cancer radical operation
pressure-controlled ventilation-volume-assured ventilation mode
pulmonary function
inflammatory reaction
