全麻下不同通气模式对重症结直肠癌腹腔镜手术患者肺功能及血清ROS和ACTH的影响被引量：1

Effects of different ventilation modes under general anesthesia on lung function,serum ROS and ACTH in patients with severe colorectal cancer undergoing laparo-scopic surgery

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摘要目的探讨全麻下不同通气模式对重症结直肠癌腹腔镜手术患者肺功能及血清活性氧和促肾上腺皮质激素的影响。方法将260例重症结直肠癌腹腔镜手术患者按照简单随机化分组方法分为A组(87例)、B组(86例)、C组(87例)。3组均给予全麻,A组给予传统通气,B组给予容量控制通气模式+肺保护性通气策略,C组给予压力控制通气模式+肺保护性通气策略。比较不同时点3组动脉血氧饱和度、平均动脉压、心率、呼气末二氧化碳分压、呼吸指数、呼吸系统动态顺应性、第1 s用力呼气容积、用力呼吸峰值流速、第1 s用力呼气容积/用力肺活量及血清活性氧和促肾上腺皮质激素水平。比较3组不良事件发生率。结果各时点3组动脉血氧饱和度、心率、平均动脉压水平比较差异无统计学意义(P>0.05);建立气腹后60 min、气腹结束后10 min 3组平均动脉压水平显著高于气腹前5 min(P<0.05)。建立气腹后60 min、气腹结束后10 min 3组呼吸指数水平较气腹前5 min时点显著升高(P<0.05或0.01),且组间比较差异有统计学意义(P<0.05或0.01);建立气腹后60 min、气腹结束后10 min 3组呼吸系统动态顺应性、呼气末二氧化碳分压水平较气腹前5 min显著降低(P<0.01),且组间比较差异有统计学意义(P<0.01)。建立气腹后60 min、气腹结束后10 min、气腹结束后20 min 3组第1 s用力呼气容积/用力肺活量、用力呼吸峰值流速、第1 s用力呼气容积水平均显著低于气腹前5 min(P<0.05或0.01)。建立气腹后60 min、气腹结束后10 min、气腹结束后20 min 3组血清活性氧、促肾上腺皮质激素水平均较气腹前5 min显著升高(P<0.05或0.01),组间比较差异有统计学意义(P<0.01)。C组不良事件发生率显著低于A组(P<0.05)。结论全麻下压力控制通气模式联合肺保护性通气策略能有效保护重症结直肠癌腹腔镜手术患者的肺功能,降低不良事件发生风险,且对血清活性� Objective To investigate the effects of different ventilation modes under general anesthesia on lung function,serum ROS and ACTH in patients with severe colorectal cancer undergoing laparoscopic surgery.Methods A total of 260 patients with severe colorectal cancer undergoing laparoscopic surgery were divided into group A(87 cases),group B(86 cases),and group C(87 cases)according to a simple randomization method.All three groups were given general anesthesia,and group A was given traditional ventilation,group B was given volume-controlled ventilation(VCV)mode+pulmonary protective ventilation strategy,and group C was given pressure-controlled ventilation mode+pulmonary protective ventilation strategy.The arterial oxygen saturation(SaO 2),mean blood pressure(MAP),heart rate(HR),end-tidal partial pressure of carbon dioxide(P ET CO 2),respiratory index(RI),pulmonary dynamic compliance(Cdyn),forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),FEV1/forced vital capacity(FEV1/FVC)and serum ROS and adrenocorticotropic hormone(ACTH)levels were compared among the three groups at different time points.The incidence of adverse events in the three groups was compared.Results There was no statistically significant difference in arterial oxygen saturation,heart rate,and mean arterial pressure among the three groups at each time point(P>0.05).The mean arterial pressure level at 60 min after the establishment of pneumoperitoneum and 10 min after the end of pneumoperitoneum was significantly higher than that 5 min before pneumoperitoneum(P<0.05).60 min after the establishment of the pneumoperitoneum and 10 min after the end of the pneumoperitoneum,the RI levels of the three groups were significantly higher than those at the 5 min before pneumoperitoneum(P<0.05 or 0.01),and the difference between the groups was statistically significant(P<0.05 or 0.01).60 min after the establishment of the pneumoperitoneum and 10 min after the end of the pneumoperitoneum,the Cdyn and the P ET CO 2 levels of the three groups were s