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| 术中呼气末正压通气对睡眠呼吸暂停综合征患者血管内皮功能的影响 |
| Effects of positive end expiratory pressure ventilation on endothelial function during general anesthesia in patients with obstructive sleep apnea syndrome patient |
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| DOI：10.12089/jca.2018.05.010 |
| 中文关键词: 呼气末正压通气 内皮素 一氧化氮 细胞黏附分子 |
| 英文关键词: Positive end expiratory pressure Endothelin Nitric oxide Cell adhesion molecules |
| 基金项目:内蒙古自然科学基金(kjt14ms873);内蒙古医科大学附属医院面上项目(NYFYYB2014014);内蒙古自治区卫生计生科研计划项目（201701071） |
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| 中文摘要: |
| 目的 观察术中5cm H2O呼气末正压通气（positive end-expiratory pressure, PEEP）对悬雍垂腭咽成型术(uvulopalatopharyngoplasty, UPPP)患者血管内皮功能的影响。方法 选取择期行UPPP的阻塞型睡眠呼吸暂停综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)患者40例, 男25例, 女15例, 年龄<60岁, BMI<30 kg/m2, ASA Ⅰ或Ⅱ级, 采用随机数字表法分为两组, 每组20例。观察组采用间歇正压通气(intermittent positive pressure ventilation, IPPV)并5 cm H2O PEEP;对照组采用单纯IPPV。分别于入室吸纯氧5 min(T0)、插管后(T1)、术毕拔管前(T2)、拔管后20 min(T3)抽动脉血样3 ml, 采用ELISA法测定血管内皮舒张因子一氧化氮(NO)、内皮素(ET)和细胞黏附分子(CAMs)的浓度。结果 两组不同时点血浆ET浓度差异无统计学意义。T2、T3时观察组血浆NO浓度明显高于对照组(P＜0.05)。与T0时比较,T2、T3时观察组，T1～T3时对照组CAMs浓度明显升高(P＜0.05)，且T2、T3时观察组血浆CAMs浓度明显低于对照组(P＜0.05)。结论 5 cm H2O PEEP改善了全麻OSAHS患者血管内皮功能。 |
| 英文摘要: |
| Ojective To observe the effect of intraoperative 5 cm H2O positive end expiratory pressure on vascular endothelial function in patients with uvulopalatopharynplasty (UPPP). Methods Forty patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) scheduled for UPPP were selected, including 25 males and 15 females, fully met the following conditions as age<60 years, BMI<30 kg/m2 and ASA physical status Ⅰ or Ⅱ. Patients were divided into two groups, 20 in each group using random number table method. The observation group was given the intermittent positive pressure ventilation (IPPV) with 5 cm H2O PEEP, while the controls group were given IPPV. 3 ml of arterial blood was drawn at the time of 5 min of pure oxygen Inhalation (T0), intubation (T1), extubation (T2), and 20 min after extubation (T3). Vascular endothelium expansion factors such as nitric oxide (NO), endothelin (ET), and soluble cell adhesion molecule (CAMs) were detected by ELISA. Results There was no significant difference in plasma ET concentrations between the two groups at different time points. Plasma NO concentration in the observation group was significantly higher than that in the control group at T2 and T3 (P＜0.05). Compared with T0, the concentrations of CAMs in the control groups from T1 to T3, and in the observation group at T2 and T3 increased significantly (P＜0.05). In the perioperative period, the plasma CAMs of the control group increased along with the prolongation of the operation time, but the plasma CAMs concentrations in the observation group decreased in the same observation time (P＜0.05). Conclusion Low level of PEEP 5 cm H2O may improve endothelial function in general anesthesia patients with OSAHS. |
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