摘要
目的 观察肢体远隔缺血预处理(RIPC)联合远隔缺血后处理(RIPostC)对胸腔镜肺切除术后肺损伤以及术后肺部并发症(PPCs)的影响.方法 纳入择期行胸腔镜肺切除术患者150例,根据随机数字表法分为两组,T组和C组,每组75例.T组于单肺通气(OLV)前和恢复双肺通气时将止血带绑于一侧上臂,实施5 min缺血/5 min再灌注3个循环的缺血预处理和后处理.采集两组患者麻醉诱导前、OLV 30 min、OLV 1 h、双肺通气后20 min、术后6 h、术后24 h时非缺血处理侧桡动脉血样,通过血气分析并记录吸入氧浓度来计算患者相应时点的氧合指数(PaO2/FiO2)、肺泡-动脉氧分压差(A-aDO2)以及呼吸指数(RI).记录机械通气相关参数,计算动态顺应性、静态顺应性以及驱动压.测定T,～T6时血浆TNF-α、IL-6、IL-10浓度,并统计患者住院期间肺部并发症及平均住院日情况.结果 两组患者在T2～T6时PaO2/FiO2低于T1、A-aDO2高于T1(P＜0.05),与C组比较,T组于T3、T5时PaO2/FiO2升高、A-aDO2降低(P＜0.05).两组患者RI于T2～T6时高于T1(P＜0.05),T组RI于T2、T3、T5时低于C组(P＜0.05).两组患者血浆IL-6、IL-10、TNF-α浓度在各时点无统计学意义(P＞0.05).T组术后24 h急性肺损伤发生率以及术后住院时间均低于C组(P＜0.05).与C组比较,OLV后30 min和1 h时T组动态顺应性和静态顺应性升高(P＜0.05).两组患者驱动压于T2～T4时高于T,(P＜0.05),T组驱动压于T2、T3时低于C组(P＜0.05).结论 肢体RIPC联合RIPostC能改善胸腔镜肺切除术围术期氧合,减轻肺损伤,减少PPCs.
Abstract
Objective To investigate the effect of limb remote ischemic preconditioning(RIPC)combined with remote ischemic postconditioning(RIPostC)on lung injury and postoperative pulmonary complications(PPCs)in patients undergoing thoracoscopic pulmonary lobectomy.Methods A total of 150 patients who underwent elective thoracoscopic pulmonary lobectomy were included in this study.According to random number table method,they were divided into two groups,Group T and Group C,with 75 cases in each group.Three circles of ischemic preconditioning and postconditioning,namely 5 min ischemia/5 min reperfusion,were performed for Group T after the tourniquet was tied to one side of the upper arm before one-lung ventilation(OLV)and during the recovery of two-lung ventilation.The blood samples of non-ischemic radial artery were collected in the two groups before anesthesia induction,30 min after OLV,1 h after OLV,20 min after two-lung ventilation,6 h after operation,and 24 h after operation,and the arterial blood gas analysis was conducted to calculate oxygenation index(PaO2/FiO2),alveolar-arterial oxygen tension difference(A-aDO2),and respiratory index(RI).The mechanical ventilation parameters were recorded.The dynamic compliance,static compliance,and driving pressure were calculated.The plasma TNF-α,IL-6,and 1L-10 concentrations were measured at T1-T6.Also,the pulmonary complications during hospitalization and the average length of stay were recorded.Results Compared with T1,PaO2/FiO2 decreased and A-aDO2 increased in the two groups at T2-T6(P＜0.05).Compared with Group C,PaO2/FiO2 increased and A-aDO2 decreased in Group T at T3 and T5(P＜0.05).Compared with T1,RI increased in the two groups at T2-T6(P＜0.05).Compared with Group C,RI decreased in Group T at T2,T3,and T5(P＜0.05).There were no statistical differences in the plasma IL-6,IL-10 and TNF-α concentrations between the two groups at each time point(P＞0.05).Compared with Group C,the incidence of acute lung injury 24 h after surgery reduced and the postoperative length of stay was shortened in Group T(P＜0.05).Compared with Group C,both dynamic compliance and static compliance increased in Group T 30 min and 1 h after OLV(P＜0.05).Compared with T1,the driving pressure increased in the two groups at T2-T4(P＜0.05).Compared with Group C,the driving pressure decreased in Group T at T2 and T3(P＜0.05).Conclusion Limb RIPC combined with RIPostC can improve perioperative oxygenation,alleviate lung injury,and reduce PPCs in patients undergoing thoracoscopic pulmonary lobectomy.
基金项目
陕西省自然科学基础研究计划重点项目(2023-JC-ZD-52)
空军军医大学唐都医院学科创新发展计划项目(2021LCYJ029)
维普
万方数据