【摘要】 目的:探讨不同时相肢体远端缺血预处理（RIPC）对胸腔镜下肺叶切除术老年患者单肺通气心肺损伤的影响。方法:将2021年5月至2022年1月本院收治且符合标准的择期全麻下行胸腔镜下肺叶切除术的老年患者60例随机分为四组:对照组（C组）、早期时相远端缺血预处理组（ER组）、延迟时相远端缺血预处理组（LR组）和不同时相联合肢体远端缺血预处理组（ER+LR组）,每组15例。分别于麻醉诱导前（T₀）,单肺通气后30分钟（T₁）,单肺通气后60分钟（T₂）,单肺通气后2h（T₃）,双肺通气后30分钟（T₄）,术后6h（T₅）时间点检测肺氧合参数及血流动力学参数;实验室测定血清TNF-α、IL-6、hs-cTnT及IL-8浓度变化;观察术后肺部并发症及心脏不良事件的发生情况。结果:组间比较发现,ER+LR组比其余三组T_3～4时点氧分压（PaO₂）升高（P<0.05）、T_3～5肺泡-动脉氧分压差（PA-aDO₂）与T₃Qs/Qt降低（P<0.05）。与T₀时点比较,四组患者T₁时点PaO₂降至最低,T_2～3时点逐渐升高;PA-aDO₂在T₁时升至最高,T_2～3时点逐渐降低（P<0.05）;且ER+LR组较之其余三组较早恢复至T₀时点水平。实验室测定结果表明,ER+LR组比其余三组T_3～5时点血浆TNF-α浓度降低（P<0.05）。与C组及ER组比较,ER+LR组T_4～5时点及LR组T₄时点血浆IL-6浓度降低（P<0.05）。另外,ER+LR组T_3～5时点IL-8、T_4～5时点hs-cTnT水平降低（P<0.05）。ER+LR组术毕肺炎及低氧血症发生率下降（P<0.05）,而心脏不良事件发生率各组间无统计学差异（P>0.05）。结论:不同时相RIPC联合应用对老年患者术中单肺通气诱发的肺损伤具有保护作用,从而降低术后肺部并发症。更多还原

【Abstract】 Objective:To investigate the effects of limb remote ischemic preconditioning（RIPC）at different time on heart and lung damage in elderly patients with single lung ventilation undergoing thoracoscopic lobotomy.Methods:Sixty elderly patients,who underwent thoracoscopic lobotomy,were randomly divided into four groups:control group（C）,early phase RIPC group（ER）,delayed phase RIPC group（LR）,and different phase combined RIPC group（ER+LR）,fifteen patients in each group.Pulmonary oxygenation parameters and hemodynamic parameters were detected before anesthesia induction（T₀）,30 min（T₁）,60 min（T₂）,120 min after single lung ventilation（T₃）,30 min after double lung ventilation（T₄）,and 6h after surgery（T₅）,respectively. In addition,serum TNF-α,IL-6,hs-cTnT and IL-8 concentrations were measured and the incidence of postoperative pulmonary complications and cardiac adverse events was observed.Results:Compared with the other three groups,the oxygen partial pressure（PaO₂）at T_3～4significantly increase,while theAlveolar-arterial oxygen differential（PA-aDO₂）at T_3～5and Qs/Qt at T₃ were markedly decreased in ER+LR group（P<0.05）.Compared with T₀,the PaO₂ at T₁ decreased to the lowest level in all groups,and gradually increased at T_2～3. The PA-aDO₂ increased to the highest level at T₁ and gradually decreased at T_2～3（P<0.05）.The PaO₂ and PA-aDO₂ in ER+LR group recovered to T₀ earlier than the other three groups. In addition,compared with the other three groups,TNF-α level at T_3～5in ER+LR group decreased more significantly（P<0.05）. And compared with C group and ER group,IL-6 levels at T_4～5in ER+LR group and T₄ in LR group decreased more significantly（P<0.05）.Meanwhile,the IL-8 at T_3～5and hs-cTnT at T_4～5decreased significantly in ER+LR group（P<0.05）. Furthermore,the incidence of post-operative pneumonia and hypoxemia in ER+LR group was significantly decreased（P<0.05）,but there was no statistical difference in the incidence of cardiac adverse（P>0.05）.Conclusion:RIPC has protective effect on lung injury caused by single-lung ventila tion in elderly patients through the synergistic effect of early and delayed ischemic preconditioning,thus reducing the postoperative pulmonary complications.更多还原