目的 探讨吸入氧浓度对合并微血管病变的糖尿病患者行腔镜胃癌根治术肺损伤的影响,用于更精准指导糖尿病患者的麻醉通气策略。方法 选取2018-10至2020-05山西医科大学第一医院行择期腔镜胃癌根治术且合并糖尿病微血管病变的患者60例,随机分为A组(FiO2 35%)、B组(FiO2 50%)和C组(FiO2 75%),每组20例。麻醉插管后3组分别以35%、50%、75%的吸入氧浓度维持机械通气,每组分别在麻醉诱导前(T0)、气腹后30 min(T1)、气腹后60 min(T2)、关气腹后10 min(T3)采取桡动脉血行血气分析并测量血清中炎性因子(TNF-α、IL-6)及氧化应激指标(SOD)、肺损伤指标(CC16)的水平。结果 在炎性因子和氧化应激水平上,与A组相比,在T2、T3时间点,C组TNF-α和IL-6水平显著升高且SOD显著降低,差异有统计学意义(P<0.05),B组TNF-α、IL-6、SOD水平变化差异无统计学意义;与C组相比,B组在T3时间点 TNF-α水平明显降低且SOD显著升高,差异有统计学意义(P<0.05);在肺损伤指标CC16水平上,在T2、T3时间点,与A组[(8.95±2.20) ng/ml、(9.96±2.16) ng/ml]相比,C组[(10.21±2.16) ng/ml、(11.98±1.89) ng/ml]CC16显著升高,差异有统计学意义(P<0.05),B组[(9.47±2.09)ng/ml、(10.87±2.10)ng/ml] CC16的浓度变化与A组相比,差异无统计学意义;在T3时间点,与C组相比,B组CC16显著降低,差异有统计学意义(P<0.05)。结论 对于糖尿病合并微血管病变行腔镜胃癌根治术的患者,50%的吸入氧浓度可能是最佳吸入氧浓度,该吸入氧浓度在保证氧供的前提下能最大程度减少氧化应激以及炎性反应。
Abstract
Objective The influence of inhaled oxygen concentrations on lung injury in diabetic patients with microangiopathy undergoing laparoscopic radical gastrectomy was investigated and the results can be used to guide the anesthesia ventilation strategies of diabetic patients more accurately.Methods 60 patients (selected from the First Hospital of Shanxi Medical University from 2018-10 to 2020-05)with diabetes and microangiopathy undergoing elective laparoscopic radical gastrectomy were randomly divided into 3 groups (n=20) with A (FiO2 35%),B (FiO2 50%),and C (FiO2 75%).After anesthesia intubation,three groups were maintained mechanically ventilated at 35%,50%,and 75% inhaled oxygen concentrations.Blood gas analysis of radial artery was performed and serum inflammatory factors (TNF-α,IL-6),oxidative stress indicators (SOD) and lung injury indicators (CC16) levels were measured in each group before induction of anesthesia (T0),30 min after pneumoperitoneum (T1),and 60 min after pneumoperitoneum (T2),10 minutes after closing the pneumoperitoneum (T3) respectively.Results In terms of level of inflammatory factors and oxidative stress,the levels of TNF-α and IL-6 in group C were significantly increased and SOD was significantly reduced at T2 and T3 time point compared with group A and the difference was statistically significant (P<0.05).For group B,the results of TNF-α,IL-6 and SOD levels were not statistically significant.Compared with group C,the level of TNF-α was significantly reduced and SOD was significantly increased at T3 time point in group B.The difference was statistically significant (P<0.05);In terms of lung injury index CC16 levels,the concentration of CC16 was significantly increased at T2 and T3 time point in group C [(10.21±2.16)ng/ml,(11.98±1.89)ng/ml] compared with group A [(8.95±2.20)ng/ml,(9.96±2.16)ng/ml] and the difference was statistically significant (P<0.05).The results difference of concentration of CC16 between group A and B [(9.47±2.09)ng/ml,(10.87±2.10) ng/ml] was not statistically insignificant;Compared with group C,the concentration of CC16 in group B was significantly reduced in at T3 time point and the difference was statistically significant (P<0.05).Conclusions For patients with diabetes and microvascular disease undergoing laparoscopic radical gastrectomy for gastric cancer,50% may be the best inspired oxygen concentration,which can minimize oxidative stress and inflammatory reactions under the premise of ensuring oxygen supply.
关键词
吸入氧浓度 /
糖尿病 /
炎性因子 /
氧化应激
Key words
inhaled oxygen concentration /
diabetes /
inflammatory factors /
oxidative stress
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