不同PEEP对全麻下骨肿瘤患者的血流动力学及呼吸功能影响

目的探讨不同呼末二氧化碳分压(PEEP)对全麻下骨肿瘤患者的血流动力学及呼吸功能影响。方法选择行手术切除与机械通气的股骨近段骨肿瘤患者88例,根据通气方法的不同分为观察组48例与对照组44例,观察组给予小流量PEEP通气,对照组给予常规流量PEEP通气,记录两组不同时间点的血流动力学及呼吸功能变化情况。结果所有患者都顺利完成麻醉、通气与手术,不同时间点的HR与MAP值都在正常范围内波动,组间与组内对比差异都无统计学意义(P>0.05)。两组术后7 d的FEV1/FVC、FEV1值都显著高于术后1 d(P<0.05),观察组也显著高于对照组(P<0.05)。两组术后7 d的血清IL-6与TNF-α值都显著低于术后1 d(P<0.05),观察组也显著低于对照组(P<0.05)。术后3个月观察组的Harris肢体功能优良率为97.9%,显著高于对照组的82.5%(P<0.05)。结论小流量PEEP通气在全麻下骨肿瘤患者手术中的应用能保持血流动力学平稳,促进呼吸功能的功能,抑制炎症因子的释放,从而改善患者的预后。

Effects of Different PEEP on Hemodynamics and Respiratory Function in Patients with Bone Tumor under General Anesthesia

Objective To investigate the effects of different end-tidal carbon dioxide partial pressure(PEEP)on hemodynamics and respiratory function in patients with bone tumor under general anesthesia.Methods 88 cases of patients with proximal femoral tumors underwent surgical resection and mechanical ventilation were selected.All cases were divided into the 48 patients in the observation group and 44 patients in the control group according to the different ventilation methods.A small flow of PEEP were given to the observation group,and the control group were given conventional flow of PEEP ventilation.The hemodynamics and respiratory function changes at different time points were recorded.Results All patients were underwent anesthesia,ventilation and surgery successfully.The HR and MAP values at different time points fluctuated within the normal range,and there were no significant difference compared between the 2 groups and within the group(P>0.05).The postoperative 7 d of FEV1/FVC and FEV1 values of the 2 groups were significantly higher than the postoperative 1 d(P<0.05),and the observation group were also significantly higher than the control group(P<0.05).The postoperative 7 d of serum IL-6 and TNF-αlevels in the 2 groups were significantly lower than the postoperative 1 d(P<0.05),and the observation group were significantly lower than the control group(P<0.05).The postoperative 3 months of excellent and good limb function of Harris in the observation group were 97.9%,which were significantly higher than that of the control group(82.5%)(P<0.05).Conclusion The application of small flow PEEP ventilation in the operation of patients with bone tumor under general anesthesia can maintain hemodynamic stability,promote respiratory function,inhibit the release of inflammatory factors,and improve the prognosis of patients.