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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。
Objective To compare the effects of low tidal volume single lung ventilation combined with positive end expiratory pressure (PEEP) and normal tidal volume single lung ventilation on lung inflammation in patients undergoing lung cancer surgery. Methods Forty patients undergoing elective lung cancer surgery were randomly divided into low tidal volume single lung ventilation combined PEEP group (L group) and normal tidal volume single lung ventilation group (N group), with 20 patients in each group. Two groups of patients were anesthetized in the induction of lung ventilation (T1), 60 min single lung ventilation (T2), 90 min single lung ventilation (T3), 60 min after the completion of dual lung ventilation (T4), postoperative Peripheral venous blood was collected on day 1 (T5). The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL) were measured by radioimmunoassay -8) and interleukin-10 (IL-10) levels. Results Compared with T1, the levels of TNF-α, IL-6, IL-8 and IL-10 in the two groups were all significantly increased (P <0.05) The levels of IL-10 at T2, T3, T4 and T5 were significantly lower in group L than those in group N at T2, T3, T4 and T5 (P <0.05). Conclusion Compared with normal tidal volume single lung ventilation, low tidal volume single lung ventilation combined with positive end-expiratory pressure can significantly reduce the inflammatory reaction in the lungs and reduce lung injury.