保护性双肺复张通气对肺癌患者血清炎性反应的影响
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摘要
目的探讨保护性双肺复张通气对肺癌患者血清炎性反应的影响。方法选择行肺叶切除术的肺癌患者124例作为研究对象,根据随机信封抽签原则分为观察组与对照组,各62例。对照组给予单肺通气,观察组给予保护性双肺复张通气,2组都为气管插管机械通气,记录血清炎性因子变化情况。结果所有患者复张前、复张后1 h的HR与MAP值都在正常范围内波动,组内对比差异无统计学意义(P> 0. 05)。治疗后1 d观察组与对照组的血清CRP水平分别为(19. 63±5. 99) ng/L和(30. 58±6. 00) ng/L,都明显低于复张前的(76. 84±7. 11) ng/L和(77. 00±8. 12) ng/L(P<0. 05),且复张后1 d观察组的CRP水平明显低于对照组(P <0. 05)。观察组复张后7 d的肺部感染、皮下气肿、气胸、下肢静脉血栓等并发症发生率为4. 8%,显著低于对照组的19. 4%(P <0. 05)。结论保护性双肺复张通气在肺癌患者中的应用能减轻血清炎性反应,有利于血流动力学波动,减少并发症的发生,有很好的应用价值。
Objective To investigate the effects of protective dual lung ventilation on serum inflammatory response in patients with lung cancer. Methods 124 lung cancer patients treated with ulmonary lobectomy were selected as the research object,all the patients were divided into the observation group and the control group,with 62 cases in each group,according to the random draw envelope principle. The control group received single lung ventilation,the observation group was given the protective dual lung ventilation,the 2 groups were given the intubation and mechanical ventilation,recorded the changes of inflammatory factor in patients with the situation. Results The HR and MAP values in all patients were within normal range,and there were no significant difference between the 2 groups( P > 0. 05). The serum CRP levels in the observation group and the control group in the 1 d after treatment were 19. 63 ± 5. 99 ng/L and 30. 58 ± 6. 00 ng/L,which were significantly lower than before treatment of 76. 84 ± 7. 11 ng/L and 77. 00 ± 8. 12 ng/L( P < 0. 05),and the observation group was significantly lower than the control group( P < 0. 05). The complication rate of pulmonary infection,subcutaneous emphysema,pneumothorax and lower limb vein thrombosis in the observation group( 4. 8%) was significantly lower than that of the control group( 19. 4%)( P < 0. 05). Conclusion The application of protective double lung ventilation in patients with lung cancer can alleviate the serum inflammatory reaction,it is beneficial to the fluctuation of hemodynamics and can reduce the occurrence of complications.
Objective To investigate the effects of protective dual lung ventilation on serum inflammatory response in patients with lung cancer. Methods 124 lung cancer patients treated with ulmonary lobectomy were selected as the research object,all the patients were divided into the observation group and the control group,with 62 cases in each group,according to the random draw envelope principle. The control group received single lung ventilation,the observation group was given the protective dual lung ventilation,the 2 groups were given the intubation and mechanical ventilation,recorded the changes of inflammatory factor in patients with the situation. Results The HR and MAP values in all patients were within normal range,and there were no significant difference between the 2 groups( P > 0. 05). The serum CRP levels in the observation group and the control group in the 1 d after treatment were 19. 63 ± 5. 99 ng/L and 30. 58 ± 6. 00 ng/L,which were significantly lower than before treatment of 76. 84 ± 7. 11 ng/L and 77. 00 ± 8. 12 ng/L( P < 0. 05),and the observation group was significantly lower than the control group( P < 0. 05). The complication rate of pulmonary infection,subcutaneous emphysema,pneumothorax and lower limb vein thrombosis in the observation group( 4. 8%) was significantly lower than that of the control group( 19. 4%)( P < 0. 05). Conclusion The application of protective double lung ventilation in patients with lung cancer can alleviate the serum inflammatory reaction,it is beneficial to the fluctuation of hemodynamics and can reduce the occurrence of complications.
引文
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[16]杨子莹,黄宁,陈祖博.麻醉诱导期使用肺保护性通气对妇科腔镜手术氧饱和度的影响[J].现代诊断与治疗,2017,28(1):138-140.
[17]Wang LL,Chen ZS,Zhou WD,et al.Down-regulated GA-TA-1 up-regulates interferon regulatory factor 3 in lung adenocarcinoma[J].Sci Rep,2017,7(1):2551.
[2]Abbasi A.Modeling of lung cancer risk due to radon exhalation of granite stone in dwelling houses[J].J Cancer Res Ther,2017,13(2):208-212.
[3]崔魁.肺保护性通气联合肺复张对老年全身麻醉患者术后动脉血氧分压及肺部功能的影响[J].国际医药卫生导报,2017,23(9):1385-1388.
[4]Wang J,Luo B,Li X,et al.Inhibition of cancer growth in vitro and in vivo by a novel ROS-modulating agent with ability to eliminate stem-like cancer cells[J].Cell Death Dis,2017,8(6):e2887.
[5]Pfirrmann D,Tug S,Brosteanu O,et al.Internet-based perioperative exercise program in patients with Barrett's carcinoma scheduled for esophagectomy[i PEP-study]a prospective randomized-controlled trial[J].BMC Cancer,2017,17(1):413.
[6]徐明霞,方波.肺保护性通气策略在肥胖患者腹腔镜手术中的应用[J].中国医师杂志,2017,19(4):622-625.
[7]Xie J,Shen S,Chen R,et al.Synthesis,characterization and antitumor activity of Ln(Ⅲ)complexes with hydrazone Schiff base derived from 2-acetylpyridine and isonicotinohydrazone[J].Oncol Lett,2017,13(6):4413-4419.
[8]刘颖,兰青,王迪芬,等.压力控制肺复张法联合俯卧位通气救治重度急性呼吸窘迫综合征患者经验[J].中华危重病急救医学,2017,29(2):177-178.
[9]Amar D,Zhang H,Pedoto A,et al.Protective lung ventilation and morbidity after pulmonary resection:A propensity score-matched analysis[J].Anesth Analg,2017,125(1):190-199.
[10]赵志刚.肺保护性通气策略对妇科腔镜手术患者肺功能的影响[J].四川医学,2017,38(3):311-315.
[11]Cavalheri V,Granger C.Preoperative exercise training for patients with non-small cell lung cancer[J].Cochrane Database Syst Rev,2017,7(6):CD012020.
[12]Cheng J,Qin B,Liu B,et al.Maternal embryonic leucine zipper kinase inhibits epithelial-mesenchymal transition by regulating transforming growth factor-βsignaling[J].Oncol Lett,2017,13(6):4794-4798.
[13]郭唯真,陈梦媛,黄天丰,等.肺保护性通气策略对食管癌根治术单肺通气老年患者脑组织炎性反应的影响[J].中华麻醉学杂志,2017,37(2):139-142.
[14]Jan N,Guy C,Reshko LB,et al.Lung and heart dose variability during radiation therapy of non-small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2017,98(3):683-690.
[15]贾子毅,刘晓伟,刘志.机械通气氧合指数对ARDS患者预后评估的价值:附228例回顾性分析[J].中华危重病急救医学,2017,29(1):45-50.
[16]杨子莹,黄宁,陈祖博.麻醉诱导期使用肺保护性通气对妇科腔镜手术氧饱和度的影响[J].现代诊断与治疗,2017,28(1):138-140.
[17]Wang LL,Chen ZS,Zhou WD,et al.Down-regulated GA-TA-1 up-regulates interferon regulatory factor 3 in lung adenocarcinoma[J].Sci Rep,2017,7(1):2551.