高氧液体在小儿单肺通气麻醉手术中应用的临床研究

doi:10.3877/cma.j.issn.1674-6902.2017.01.009

目的

探讨高氧液体在小儿单肺通气麻醉手术中应用效果。

方法

选择2014年7月至2016年7月我院行麻醉手术的单肺通气患儿30例，均行肺叶切除术，通过随机数表法分为A组(n＝15)和B组(n＝15)，A组患儿在单肺通气后通过30 ml(kg·h)的速度，恒速输入醋酸林格高氧液体，B组患儿用同样的速度输入等量的醋酸林格液体。比较两组患儿术中血气分析、炎性因子变化以及术后情况。

结果

两组患儿在T0(通气前)、T1(通气10 min)、T2(通气30 min)、T3(通气60 min)、T4(通气2 h)时，pH、动脉氧分压(PaO₂)、混合静脉血氧分压()、混合静脉血氧饱和度()水平均发生不同程度下降(P<0.05)，但A组在T1、T2、T3、T4时，pH、PaO₂、、水平均高于B组(P<0.05)；两组患儿T1、T2、T3、T4时肿瘤坏死因子(TNF)-α、白介素(IL)-6、IL-8、IL-10、丙二醛(MDA)水平较T0时比较，均出现不同程度的升高(P<0.05)；A组在T1、T2、T3、T4时，TNF-α、IL-6、IL-8、MDA均比B组低(P<0.05)；A组苏醒时间短于B组(P<0.05)，躁动发生率比B组低(P<0.05)。

结论

在小儿麻醉手术行单肺通气后输注高氧液体，可有效预防低氧血症的发生，减轻炎性反应，安全性高，值得应用推广。

关键词: 高氧液体, 单肺通气, 低氧血症, 血气分析, 炎性因子

Objective

To study curative efficacy of high oxygen liquid of one lung ventilation anesthesia in children.

Methods

30 children of one lung ventilation anesthesia who received therapy from July 2014 to July 2016 in our hospital were selected as research objects. According to random number table, all underwent pulmonary lobectomy, those children were divided into the A group (n=15) and the B group (n=15). The A group after one lung ventilation, was treated with the 30 ml (kg·h) speed, constant speed input acetated glygoyle liquid oxygen, while the B group was treated with acetated ringer liquid injected the same speed.Then intraoperative blood gas analysis and inflammatory factor changesand postoperative conditions were compared.

Results

The pH, arterial oxygen partial pressure (PaO₂), mixed venous oxygen partial pressure () and mixed venous oxygen saturation () in the two groups were decreased in different degrees in T0 (before ventilation), T1 (ventilation 10 min), T2 (ventilation 30 min), T3 (ventilation 60 min), T4 (ventilation 2 h)(P<0.05), but the levels of pH, PaO_2, , in A group were higher than the B group in T1, T2, T3, T4(P<0.05); the levels of tumor necrosis factor (TNF)-α, interleukin (IL) -6, IL-8, IL-10, malondialdehyde (MDA) in the T1, T2, T3, T4 compared with T0, were all increased in different degrees in the two groups(P<0.05), but the level of TNF-α, IL-6, IL-8, MDA in A group were lower than B group in T1, T2, T3, T4(P<0.05); the recovery time in A group was shorter than that the B group(P<0.05), the incidence rate of agitation was lower than the B group(P<0.05).

Conclusions

The constant input of acetated high oxygen liquid is well for one lung ventilation anesthesia in children, which can preventing the occurrence of hypoxia, reduce the inflammatory reaction, high security, it′s worthy of application and promotion.

Key words: High oxygen liquid, One-lung ventilation, Hypoxia, Blood gas analysis, Inflammatory factor

表1 两组患儿不同时间点血气分析结果(±s)

指　标	组别	T0	T1	T2	T3	T4
pH	A组	7.84±0.59	7.65±0.43^ab	7.58±0.32^ab	7.51±0.28^ab	7.49±0.34^ab
?	B组	7.88±0.54	7.39±0.34^a	7.31±0.31^a	7.25±0.26^a	7.21±0.24^a
PaO₂(mmHg)	A组	237.34±24.09	210.32±22.31^ab	184.35±17.84^ab	180.34±17.45^ab	174.51±15.12^ab
?	B组	240.12±23.45	188.34±21.56^a	145.32±15.34^a	132.12±14.34^a	127.34±14.83^a
(mmHg)	A组	53.41±8.45	48.54±7.81^a	44.50±7.56^ab	43.12±6.95^ab	42.83±7.12^ab
?	B组	53.47±8.34	42.93±7.64^a	38.94±7.41^a	36.87±7.13^a	35.73±7.02^a
(%)	A组	78.43±5.91	72.83±5.12^ab	69.09±4.83^ab	67.43±4.71^ab	66.83±4.60^ab
?	B组	78.59±5.72	69.65±4.85^a	64.12±4.76^a	62.10±4.31^a	60.84±4.20^a

表1 两组患儿不同时间点血气分析结果(±s)

指　标	组别	T0	T1	T2	T3	T4
pH	A组	7.84±0.59	7.65±0.43^ab	7.58±0.32^ab	7.51±0.28^ab	7.49±0.34^ab
?	B组	7.88±0.54	7.39±0.34^a	7.31±0.31^a	7.25±0.26^a	7.21±0.24^a
PaO₂(mmHg)	A组	237.34±24.09	210.32±22.31^ab	184.35±17.84^ab	180.34±17.45^ab	174.51±15.12^ab
?	B组	240.12±23.45	188.34±21.56^a	145.32±15.34^a	132.12±14.34^a	127.34±14.83^a
(mmHg)	A组	53.41±8.45	48.54±7.81^a	44.50±7.56^ab	43.12±6.95^ab	42.83±7.12^ab
?	B组	53.47±8.34	42.93±7.64^a	38.94±7.41^a	36.87±7.13^a	35.73±7.02^a
(%)	A组	78.43±5.91	72.83±5.12^ab	69.09±4.83^ab	67.43±4.71^ab	66.83±4.60^ab
?	B组	78.59±5.72	69.65±4.85^a	64.12±4.76^a	62.10±4.31^a	60.84±4.20^a

表2 两组患儿不同时间点炎性因子变化(±s)

指　标	组别	T0	T1	T2	T3	T4
TNF-α(ng/L)	A组	13.02±2.30	17.43±2.49^ab	18.34±2.03^ab	18.54±2.33^ab	18.63±2.37^ab
?	B组	13.05±2.25	19.45±3.45^a	25.95±4.12^a	27.83±3.41^a	27.75±3.53^a
IL-6(ng/L)	A组	13.28±2.56	15.34±2.74^ab	16.03±2.83^ab	16.12±2.79^ab	16.38±2.95^ab
?	B组	13.30±2.51	17.84±3.01^a	19.83±3.15^a	21.23±3.20^a	21.33±3.62^a
IL-8(ng/L)	A组	6.78±1.24	7.38±1.30^a	7.52±1.42^ab	7.61±1.39^ab	7.65±1.34^ab
?	B组	6.81±1.20	8.95±1.68^a	10.34±2.08^a	12.45±2.51^a	13.02±2.93^a
IL-10(ng/L)	A组	20.31±4.03	27.84±5.14^ab	29.58±6.86^ab	32.85±7.43^ab	33.40±7.49^ab
?	B组	20.39±3.87	24.02±4.12^a	25.87±5.12^a	25.75±5.40^a	25.98±5.58^a
MDA(μmol/L)	A组	8.45±1.23	11.34±1.57^ab	12.03±1.68^ab	13.17±2.31^ab	14.03±2.41^ab
?	B组	8.48±1.20	14.93±2.05^a	17.84±2.43^a	19.08±3.23	20.94±3.67^a

表2 两组患儿不同时间点炎性因子变化(±s)

指　标	组别	T0	T1	T2	T3	T4
TNF-α(ng/L)	A组	13.02±2.30	17.43±2.49^ab	18.34±2.03^ab	18.54±2.33^ab	18.63±2.37^ab
?	B组	13.05±2.25	19.45±3.45^a	25.95±4.12^a	27.83±3.41^a	27.75±3.53^a
IL-6(ng/L)	A组	13.28±2.56	15.34±2.74^ab	16.03±2.83^ab	16.12±2.79^ab	16.38±2.95^ab
?	B组	13.30±2.51	17.84±3.01^a	19.83±3.15^a	21.23±3.20^a	21.33±3.62^a
IL-8(ng/L)	A组	6.78±1.24	7.38±1.30^a	7.52±1.42^ab	7.61±1.39^ab	7.65±1.34^ab
?	B组	6.81±1.20	8.95±1.68^a	10.34±2.08^a	12.45±2.51^a	13.02±2.93^a
IL-10(ng/L)	A组	20.31±4.03	27.84±5.14^ab	29.58±6.86^ab	32.85±7.43^ab	33.40±7.49^ab
?	B组	20.39±3.87	24.02±4.12^a	25.87±5.12^a	25.75±5.40^a	25.98±5.58^a
MDA(μmol/L)	A组	8.45±1.23	11.34±1.57^ab	12.03±1.68^ab	13.17±2.31^ab	14.03±2.41^ab
?	B组	8.48±1.20	14.93±2.05^a	17.84±2.43^a	19.08±3.23	20.94±3.67^a

表3 两组患儿拔管时间、苏醒时间、躁动例数比较(±s)

组　别	例数	拔管时间	苏醒时间	躁动[n(%)]
A组	15	14.85±1.58	41.23±3.04	1(6.67)
B组	15	14.74±1.60	54.78±5.12	6(40.00)
t(χ²)值	?	0.189	8.813	2.981
P值	?	0.851	0.000	0.084

表3 两组患儿拔管时间、苏醒时间、躁动例数比较(±s)

组　别	例数	拔管时间	苏醒时间	躁动[n(%)]
A组	15	14.85±1.58	41.23±3.04	1(6.67)
B组	15	14.74±1.60	54.78±5.12	6(40.00)
t(χ²)值	?	0.189	8.813	2.981
P值	?	0.851	0.000	0.084

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选择文件类型/文献管理软件名称

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Curative efficacy of high oxygen liquid of one lung ventilation anesthesia in children

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选择文件类型/文献管理软件名称

选择包含的内容

Curative efficacy of high oxygen liquid of one lung ventilation anesthesia in children