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

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (740 KB)
输出: BibTeX | EndNote (RIS)

摘要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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张亚阳
	王建刚
	李婷
	朱健
	岳隆基

关键词 ：吸入氧浓度, 糖尿病, 炎性因子, 氧化应激

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.

Key words： inhaled oxygen concentration diabetes inflammatory factors oxidative stress

收稿日期: 2020-08-27

ZTFLH:	R614.2
	R656.61

通讯作者: 王建刚,E-mail:chinawjgmz@163.com

作者简介: 张亚阳,硕士研究生。

引用本文:

张亚阳, 王建刚, 李婷, 朱健, 岳隆基. 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[J]. 武警医学, 2021, 32(1): 46-50. ZHANG Yayang, WANG Jiangang, LI Ting, ZHU Jian, YUE Longji. Influence of inhaled oxygen concentrations on lung injury in diabetic patients with microangiopathy undergoing laparoscopic radical gastrectomy. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(1): 46-50.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2021/V32/I1/46

[1]	Muhammad I,Abdul J,Ahmed S,et al.Pulmonary functions in patients with diabetes mellitus[J].Lung India,2011,28(2):89-92.
[2]	Van den Borst B,Gosker H R,Zeegers M P,et al.Pulmonary function in diabetes:a metaanalysis[J].Chest,2010,138(2):393-406.
[3]	甄月巧,杨篷,杨震,等.2型糖尿病患者肺功能变化及相关风险因素分析[J].中国糖尿病杂志,2013,21(1):36-38.
[4]	林武洲,彭德珍,陈梅唏,等.2型糖尿病患者肺功能及HbA1c检测分析[J].现代预防医学,2013,40(14):2742-2744.
[5]	张喆,曹大伟,张新日.高氧肺损伤机制研究进展[J].国际呼吸杂志,2018,38(6):461-464.
[6]	邓伟吾.糖尿病的肺功能损害和肺部并发症[J].临床肺科杂志,2010,15(7):903-905.
[7]	Antonelli Incalzi R,Fuso L,Gonlano A,et al.Neuroadrenergic denervation of the lung in type I diabetes mellitus complicated by autonomic neuropathy[J].Chest,2002,121(2):443-451.
[8]	Dennis R J,Maldonado D,Rojas M X,et al.Inadequate glucose control in type 2 diabetes is associated with impaired lung function and systemic inflammation:a cross-sectional study[J].BMC Pulm Med,2010,10:38.
[9]	Landis S E,Schwarz M,Curran D R.North Carolina family medicine residency programs diabetes learning collaborative[J].Fam Med,2006,38(3):190-195.
[10]	常俊晓,邢群智,李毓,等.机械通气中吸入不同氧浓度对正常肺动脉血氧分压及炎症介质的影响[J].临床与病理杂志,2018,38(3):530-537.
[11]	Kallet R H,Matthay M A.Hyperoxic acute lung injury[J].Respir Care,2013,58(1):123-141.
[12]	Reynolds P R,Schmitt R E,Kasteler S D,et al.RecePtors for advanced glycation end-products targeting protect against hyperoxia-induced lung injury in mice[J].Am J Respir Cell Mol Biol,2010,42(5):545-551.
[13]	Ehrhardt H,Pritzke T,Oak P,et al.Absence of TNF-α enhances inflammatory response in the newborn lung undergoing mechanical ventilation[J].Am J Physiol Lung Cell Mol Physiol,2016,310(10):L909-L918.
[14]	乐海浪,罗国强.创伤后早期炎症因子TNF-α、IL-1、IL-6的研究进展[J].现代诊断与治疗,2014,25(4):763-765.
[15]	Lillian M,Silva P L,Alessandra T,et al.Impact of different tidal volume levels at low mechanical power on ventilator-induced lung injury in rats[J].Front Physiol,2018,9:318.
[16]	Chuang C Y,Degendorfer G,Davies M J.Oxidation and modification of extracellular matrix and its role in disease[J].Free Radic Res,2014,48(9):970-989.
[17]	Susana C.ROS and redox signaling in myocardial ischemia-rePerfusion injury and cardio protection[J].Free Radic Biol Med,2018,117:76-89.
[18]	Peric A,Mirkovic C Š,Durdevic B V,et al.Eosinophil chemokines and clara cell protein 16 production in nasal mucosa of patients with persistent allergic rhinitis[J].Eurasian J Med,2017,49(3):178-182.