低潮气量单肺通气复合呼气末正压对肺癌手术患者肺部炎症反应的影响

目的：对比低潮气量单肺通气复合呼气末正压（PEEP）与正常潮气量单肺通气对肺癌手术患者肺部炎症反应的影响。方法40例择期肺癌手术患者随机分为低潮气量单肺通气复合PEEP组（L组）和正常潮气量单肺通气组（N组）,每组20例。两组患者分别在麻醉诱导后双肺通气时（T1）、单肺通气60 min时（T2）、单肺通气90 min时（T3）、术毕双肺通气60 min时（T4）、术后1 d（T5）采取外周静脉血,采用放射酶联免疫吸附法（ELISA）测量肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）及白细胞介素-10（IL-10）水平。结果与T1比较,两组各时点血浆TNF-α, IL-6, IL-8及IL-10水平均持续升高（P〈0.05）；L组TNF-α, IL-6, IL-8在T2、T3、T4、T5时间点均明显低于N组（P〈0.05）；L组血浆IL-10在T2、T3、T4、T5时间点明显高于N 组（P〈0.05）。结论与正常潮气量单肺通气相比,采用低潮气量单肺通气复合呼气末正压可明显减轻肺部的炎症反应,从而减轻肺部损伤。

Effect of low tidal volume one lung ventilation plus positive end-expiratory pressure on inflammatory responses of pulmonary in patients with lung cancer operation

Objective To compare the effect of low tidal volume and normal tidal volume one lung ventilation plus positive end-expiratory pressure（PEEP） on inflammatory responses of pulmonary in patients with lung cancer operation.Methods Divided 40 patients with lung cancer operation into PEEP group（group L） and normal tidal volume one lung ventilation group（goup N）, 20 cases in each group, tumor necrosis factor-α（TNF-α）, Interleukin-6（IL-6）, Interleukin-8（IL-8） and Interleukin-10（IL-10） were assessed with ELISA on the following time①two lung ventilation after anesthesia induction（T1）; ②60 min after one lung ventilation （T2）; ③90 min after one lung ventilation （T3）; ④60 min after two lung ventilation（T4）; ⑤1d after operation （T5）. Results Compared to T1, TNF-α、IL-6、IL-8 and IL-10 were increased in other time point in both groups. The TNF-α、IL-6、IL -8 in group L were significant decreased than group N in T2, T3, T4, T5 time point（P〈0.05）. The IL-10 in group L were significant increased than group N in T2, T3, T4, T5 time point（P〈0.05）.Conclusion Low tidal volume one lung ventilation plus positive end-expiratory pressure can lessen pulmonary inflammatory response obviously than normal tidal volume and relieve the lung injury.