肺保护性通气对不同MELD分值肝移植手术患者的肺保护作用

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Abstract Objective To assess the influence of lung protective mechanical ventilation strategy on patients who had different MELD scores during liver transplantation surgery.Methods Eighty patients of both sexes, of American Society of Anesthesiologists physical status Ⅱor Ⅳ,and scheduled for liver transplantation under general anesthesia,were divided into four groups according to the evaluation by MELD scoring system and mechanical ventilation mode: MELD≤15 with conventional mechanical ventilation group(group Ⅰc),MELD≤15 with protective mechanical ventilation group(group Ⅰp) ,MELD>15 with conventional mechanical ventilation group(group Ⅱc) and MELD>15 with protective mechanical ventilation group(group Ⅱp). Blood samples from the radial artery, plasma markers of lung injury and inflammatory mediators were collected at 8 time points: before operation(T₁), 3 h into the preanhepatic stage (T₂), 30min into the anhepatic stage(T₃),2 h (T₄), 4h into the neohepatic stage(T₅), 2h after operation (T₆),before extubation (T₇) and 1 d after operation (T₈).Plasma markers of lung injury, which were clara cell secretory protein 16(CC16)and inflammatory mediators, such as TNF-α and IL-8, were monitored. Moreover, the oxygenation index (OI),time eyes were opened, time of tracheal extubation,lenghth of ICU stay and acute lung injury incidence within 1 week were recorded.Results Patients with MELD scores above 15 showed a larger blood transfusion volume, a longer duration of surgery and a lower OI(P<0.05 or P<0.01). A higher incidence of acute lung injury,an earlier tracheal extubation and a longer stay of ICU were found(P<0.01). In addition,levels of CC16,TNF-α and IL-8 were higher(P<0.05 or P<0.01) in these groups. Among patients who had performed the lung protective mechanical ventilation strategy, the tracheal extubation time was (7.2±1.5) and (12.1±5.6)h respectively,which was earlier than that of patients in conventional mechanical ventilational groups (P<0.05).Conclusions The lung protective mechanical ventilation strategy may contribute to the protection of lung function in liver transplantation for patients with a higher MELD score by reducing the incidence of acute lung injury, elevating the OI and shortening tracheal extubation.

Key words： lung protective mechanical ventilation strategy model for end-stage liver disease liver transplatation acute lung injury plasma markers of lung injury

Received: 01 January 2018

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	LI Zhanjun
	ZHANG Qianlong
	CHEN Xiaoyang
	DONG Lan

Cite this article:

LI Zhanjun,ZHANG Qianlong,CHEN Xiaoyang等. Influence of lung protective mechanical ventilation strategy on patients with different MELD scores during liver transplantation surgery[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2018, 29(4): 388-392.

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2018/V29/I4/388

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