吸入氧浓度对合并微血管病变的糖尿病患者行腔镜胃癌根治术肺损伤的影响

目的 探讨吸入氧浓度对合并微血管病变的糖尿病患者行腔镜胃癌根治术肺损伤的影响,用于更精准指导糖尿病患者的麻醉通气策略.方法 选取2018-10至2020-05山西医科大学第一医院行择期腔镜胃癌根治术且合并糖尿病微血管病变的患者60例,随机分为A组(FiO235％)、B组(FiO250％)和C组(FiO275％),每组2...

Influence of inhaled oxygen concentrations on lung injury in diabetic patients with microangiopathy undergoing laparoscopic radical gastrectomy

Objective The influence of inhaled oxygen concentrations on lung injury in diabetic patients with microangiopathy undergoing laparoscopic radical gastrectomy was investigated and the results can be used to guide the anesthesia ventilation strategies of diabetic patients more accurately.Methods 60 patients (selected from the First Hospital of Shanxi Medical University from 2018-10 to 2020-05)with diabetes and microangiopathy undergoing elective laparoscopic radical gastrectomy were randomly divided into 3 groups (n=20) with A (FiO₂ 35%),B (FiO₂ 50%),and C (FiO₂ 75%).After anesthesia intubation,three groups were maintained mechanically ventilated at 35%,50%,and 75% inhaled oxygen concentrations.Blood gas analysis of radial artery was performed and serum inflammatory factors (TNF-α,IL-6),oxidative stress indicators (SOD) and lung injury indicators (CC16) levels were measured in each group before induction of anesthesia (T₀),30 min after pneumoperitoneum (T₁),and 60 min after pneumoperitoneum (T₂),10 minutes after closing the pneumoperitoneum (T₃) respectively.Results In terms of level of inflammatory factors and oxidative stress,the levels of TNF-α and IL-6 in group C were significantly increased and SOD was significantly reduced at T₂ and T₃ time point compared with group A and the difference was statistically significant (P<0.05).For group B,the results of TNF-α,IL-6 and SOD levels were not statistically significant.Compared with group C,the level of TNF-α was significantly reduced and SOD was significantly increased at T3 time point in group B.The difference was statistically significant (P<0.05);In terms of lung injury index CC16 levels,the concentration of CC16 was significantly increased at T₂ and T₃ time point in group C (10.21±2.16)ng/ml,(11.98±1.89)ng/ml] compared with group A (8.95±2.20)ng/ml,(9.96±2.16)ng/ml] and the difference was statistically significant (P<0.05).The results difference of concentration of CC16 between group A and B (9.47±2.09)ng/ml,(10.87±2.10) ng/ml] was not statistically insignificant;Compared with group C,the concentration of CC16 in group B was significantly reduced in at T₃ time point and the difference was statistically significant (P<0.05).Conclusions For patients with diabetes and microvascular disease undergoing laparoscopic radical gastrectomy for gastric cancer,50% may be the best inspired oxygen concentration,which can minimize oxidative stress and inflammatory reactions under the premise of ensuring oxygen supply.