CAJ | 학술논문

目的观察瑞芬太尼对单肺通气患者炎症反应和氧合功能的影响.方法择期开胸手术行单肺通气患者30例,按照随机排列表分为生理盐水对照组(C组)和瑞芬太尼治疗组(R组),每组15例.两组患者在单肺通气前1 min(T1),单肺通气结束后3 min(T2)及其后30 min(T3)各时间点进行动脉血气分析及计算肺内分流率(Qs/Qt)和氧合指数值(PaO2/FiO2),并采取颈内静脉血测定细胞因子及炎性介质的活性.结果同T1时相比:C组Qs/Qt在T2、T3时显著升高(P＜0.05)[(15.1±4.6)％vs.(11.5±3.4)％,(16.7±3.9)％vs.(11.5±3.4)％],而paO2/FiO2在T2、T3时显著下降(P ＜0.05)[(397 ±95) mm Hg vs.(471±69) mmHg,(384±78) mm Hg vs.(471±69) mmHg](1 mmHg=0.133 kPa);R组Qs/Qt在T2时显著升高(P＜0.05)[(14.5±2.3)％vs.( 11.8±2.5)％],PaO2/FiO2在T2时显著下降(P＜0.05)[(410±45) mm Hg vs.(465±50) mmHg].同T2时相比:R组Qs/Qt在T3时显著下降(P＜0.05)[(12.0±2.3)％vs.(14.5±2.3)％],而PaO2/FiO2显著升高(P＜0.05)[(460±45) mm Hg vs.(410±45) mmHg].组间比较:R组Qs/Qt在T3时较C组显著下降(P＜0.05)[(12.0±2.3)％vs.(16.7±3.9)％],而PaO2/FiO2显著升高(P＜0.05)[(460±45) mmHg vs.(384±78) mm Hg].两组中性粒细胞在T2、T3时显著升高(P＜0.05),R组超氧化物歧化酶(SOD)在T2、T3时显著高于C组(P＜0.05)[ (58±4) U/ml vs.(53±7) U/ml,(57±5) U/ml vs.(50±9) U/ml],而丙二醛(MDA)、细胞间黏附分子-1 (ICAM-1)显著低于C组(P＜0.05)；R组肿瘤坏死因子-α(TNF-α)在T3时显著低于C组(P＜0.05).相关分析表明:TNF-α和ICAM-1,PaO2/FiO2和SOD,Qs/Qt和MDA有一定的相关性(P＜0.05).结论瑞芬太尼对单肺通气患者炎症反应和氧合功能具有一定的保护作用.
목적 관찰서분태니대단폐통기환자염증반응화양합공능적영향.방법 택기개흉수술행단폐통기환자30례,안조수궤배렬표분위생리염수대조조(C조)화서분태니치료조(R조),매조15례.량조환자재단폐통기전1 min(T1),단폐통기결속후3 min(T2)급기후30 min(T3)각시간점진행동맥혈기분석급계산폐내분류솔(Qs/Qt)화양합지수치(PaO2/FiO2),병채취경내정맥혈측정세포인자급염성개질적활성.결과 동T1시상비:C조Qs/Qt재T2、T3시현저승고(P＜0.05)[(15.1±4.6)％vs.(11.5±3.4)％,(16.7±3.9)％vs.(11.5±3.4)％],이paO2/FiO2재T2、T3시현저하강(P ＜0.05)[(397 ±95) mm Hg vs.(471±69) mmHg,(384±78) mm Hg vs.(471±69) mmHg](1 mmHg=0.133 kPa);R조Qs/Qt재T2시현저승고(P＜0.05)[(14.5±2.3)％vs.( 11.8±2.5)％],PaO2/FiO2재T2시현저하강(P＜0.05)[(410±45) mm Hg vs.(465±50) mmHg].동T2시상비:R조Qs/Qt재T3시현저하강(P＜0.05)[(12.0±2.3)％vs.(14.5±2.3)％],이PaO2/FiO2현저승고(P＜0.05)[(460±45) mm Hg vs.(410±45) mmHg].조간비교:R조Qs/Qt재T3시교C조현저하강(P＜0.05)[(12.0±2.3)％vs.(16.7±3.9)％],이PaO2/FiO2현저승고(P＜0.05)[(460±45) mmHg vs.(384±78) mm Hg].량조중성립세포재T2、T3시현저승고(P＜0.05),R조초양화물기화매(SOD)재T2、T3시현저고우C조(P＜0.05)[ (58±4) U/ml vs.(53±7) U/ml,(57±5) U/ml vs.(50±9) U/ml],이병이철(MDA)、세포간점부분자-1 (ICAM-1)현저저우C조(P＜0.05)；R조종류배사인자-α(TNF-α)재T3시현저저우C조(P＜0.05).상관분석표명:TNF-α화ICAM-1,PaO2/FiO2화SOD,Qs/Qt화MDA유일정적상관성(P＜0.05).결론 서분태니대단폐통기환자염증반응화양합공능구유일정적보호작용.
Objective To observe the effects of remifentanil on inflammatory responses and oxygenation induced by one lung ventilation (OLV). Methods Thirty patients undergoing one lung ventilation during thoracic surgery were randomly divided into control (C) and remifentanil (R) group,which were treated with saline or remifentanil respectively.Blood samples of arterial and jugular vein were taken 1 min before OLV (T1),3 min after completion of OLV (T2),and 30 min after T2 (T3),for detecting blood gas analysis,serum levels of neutrophil,superoxide dismutase (SOD),malondialdehyde (MDA),intercellular adhesion molecule-1 (ICAM-1),and tumor necrosis factor-α (TNF-α) Results Compared to those at T1,intrapulmonary shunt (Qs/Qt) increased significantly [ ( 14.5±2.3 )％ vs.( 11.8±2.5 )％,( 15.1 ±4.6 ) ％ vs.( 11.5±3.4)％ ] and oxygen index (PaO2/FiO2) decreased significantly [(410±45) mm Hg vs.(465±50) mm Hg,(397±95) mm Hg vs.(471±69) mm Hg] (1 mm Hg=0.133 kPa) in control group.Qs/Qt was higher and PaO2/FiO2 was lower at T2 than those at T1 in group R(P＜0.05) [ (14.5±2.3)％ vs.( 11.8±2.5)％,(410±45) mm Hg vs.(465±50) mm Hg];Qs/Qt was lower and PaO2/FiO2 was higher at T3 than those at T2 in group R (P＜ 0.05)[(12.0±2.3)％ vs.(14.5±2.3)％,(460±45) mm Hg vs.(410±45) mm Hg ].Q s/Qt was lower and PaO2/FiO2 was higher at T3 in group R than those in group C (P＜0.05) [(12.0±2.3)％ vs.(16.7±3.9)％,(460±45) mm Hg vs.(384±78) mm Hg].Serum SOD content in group R was higher than that in group C at T2 and T3 (P＜0.05).While MDA and ICAM-1 level were significantly decreased in group R than those in group C,serum TNF-α was lower at T3 in group R than those in group C (P＜0.05).Further analysis showed that there is positive correlation between PaO2/FiO2 and SOD (P＜0.05),Qs/Qt and MDA (P＜0.05),TNF-α and ICAM-1 (P＜0.05). Conclusions Remifentanil has protective effects on inflammatory responses and oxygenation during one lung ventilation.