国际麻醉学与复苏杂志   2022, Issue (4): 0-0
    
鼻咽和口咽导管介导IHFJV下肺癌患者PLVB 诊疗中血气及快速反应基因对比研究
田海涛, 张亚东, 许崇晓, 辛楠, 宋成伟, 尤培军1()
1.济宁市第一人民医院麻醉科
Comparison of blood gas analysis and rapid response‑like genes in the diagnosis and treatment of lung cancer patients under intermittent high frequency jet ventilation mediated
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摘要：

目的 探讨鼻咽导管和口咽导管介导间歇性高频喷射通气（intermittent high frequency jet ventilation, IHFJV）下无痛电子支气管镜（painless video bronchoscopes, PLVB）诊疗过程中，患者血气指标及快速反应基因表达的差异，为肺癌患者PLVB诊疗的通气方式提供指导。 方法 选择接受PLVB诊疗的肺癌患者180例，按随机数字表法分为鼻咽导管介导IHFJV组（对照组）和口咽导管介导IHFJV组（试验组），每组90例。完善麻醉后，两组患者分别给予鼻咽导管和口咽导管介导IHFJV供氧，并实施PLVB。分别于术前20 min（T1）、手术开始5 min（T2）和术后5 min（T3）采集两组患者血液样本，行血气分析，记录pH值、总二氧化碳（total carbon dioxide, TCO2）、PaO2、PaCO2、肺泡‑动脉氧分压差（alveolar‑arterial oxygen difference, A‑aDO2）、碳酸氢根（bicarbonate radical, HCO3−）和碱剩余（base excess, BE）等指标，并应用实时荧光定量PCR（real‑time fluorescent quantitative PCR, RT‑qPCR）法检测两组患者各时点血液中与缺氧应激有关快速反应样基因超敏C反应蛋白（hypersensitive C‑reactive protein, hs‑CRP）mRNA及缺氧诱导因子‑1α（hypoxia inducible factor‑1α, HIF‑1α）mRNA的相对含量。 结果 与对照组比较，试验组T3时PaO2升高、A‑aDO2降低（P<0.05）；与T1时比较，两组患者T2时PaO2升高、A‑aDO2降低（P<0.05）。与T1时比较，两组患者T2、T3时血液中hs‑CRP mRNA、HIF‑1α mRNA相对含量降低（P<0.05）。其他指标差异无统计学意义（P>0.05）。 结论 肺癌患者接受PLVB诊疗时，鼻咽导管和口咽导管介导IHFJV均能提供良好的通气效果，但口咽导管可能更佳。
关键词： 无痛电子支气管镜； 鼻咽导管； 口咽导管； 间歇性高频喷射通气； 缺氧应
Abstract:

Objective To investigate the difference of blood gas analysis and the expression of rapid response‑like genes under intermittent high frequency jet ventilation (IHFJV) mediated by nasopharyngeal catheter and oropharyngeal catheter by painless video bronchoscopy (PLVB), so as to provide guidance for the diagnosis and treatment with PLVB in lung cancer patients. Methods A total of 180 lung cancer patients who were treated by PLVB were enrolled. According to the random number table method, they were randomly divided into two groups (n=90): a control group under nasopharyngeal catheter mediated IHFJV and an experimental group under oropharyngeal catheter mediated IHFJV. After completion of anesthesia, oxygen was supplied for nasopharyngeal catheter mediated IHFJV and oropharyngeal catheter mediated IHFJV, and PLVB was performed. Then, blood samples were collected 20 min before surgery (T1), 5 min after the beginning of surgery (T2) and at postoperative 5 min (T3) for blood gas analysis. Furthermore, pH value, total carbon dioxide (TCO2), arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), alveolar‑arterial oxygen difference (A‑aDO2), bicarbonate radical (HCO3‒ ), and base excess (BE) were recorded. Meanwhile, real‑time fluorescent quantitative PCR (RT‑qPCR) was used to detect the relative levels of rapid‑response genes related to hypoxia stress in the blood of patients, including hypersensitive C‑reactive protein (hs‑CRP) and hypoxia inducible factor‑1α (HIF‑1α). Results At T3, the experimental group showed increases in PaO2 and decreases in A‑aDO2, compared with the control group (P<0.05). Compared with those at T1, PaO2 increased and A‑aDO2 decreased in both groups at T2 (P<0.05). Compared with those at T1, the relative levels of hs‑CRP and HIF‑1α mRNA in the two groups significantly decreased at T2 and T3. There were no significant differences in other indexes (P>0.05). Conclusions Both nasopharyngeal catheter mediated IHFJV and oropharyngeal catheter mediated IHFJV can provide good ventilation in lung cancer patients during diagnosis and treatment with PLVB, but oropharyngeal catheter may exhibit better effects.
Key words: Painless video bronchoscopy; Nasopharyngeal catheter; Oropharyngeal catheter; Intermittent high frequency jet ventilation; Hypoxic stress; Rapid response‑like gene