中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
27期
4304-4309
,共6页
组织构建%移植%肺移植%麻醉%应激%能量代谢%全静脉麻醉%硬膜外麻醉%肺功能%血气分析
組織構建%移植%肺移植%痳醉%應激%能量代謝%全靜脈痳醉%硬膜外痳醉%肺功能%血氣分析
조직구건%이식%폐이식%마취%응격%능량대사%전정맥마취%경막외마취%폐공능%혈기분석
lung transplantation%energy metabolism%anesthesia%epidural%blood gas analysis
背景：在非体外循环的条件下，保证患者在麻醉效果良好的情况下完成序贯式双肺移植，胸段硬膜外复合全静脉麻醉和全静脉麻醉的选择上尚存在争议。<br> 目的：观察序贯式双肺移植过程中两种不同的麻醉方式对患者呼吸功能及肺生物学功能的影响。<br> 方法：将24例序贯式双肺移植患者分为全静脉麻醉组及硬膜外复合全静脉麻醉组。对两组患者麻醉后单、双肺通气10 min后的氧耗量、二氧化碳排出量、呼吸商和能量消耗进行测定。同时，对比分析两组患者移植过程中去甲肾上腺素、肾上腺素、皮质醇以及血糖水平参数变化。<br> 结果与结论：两组患者在移植后6个月、1年及3年的随访调查中，肺功能均得到明显的改善，血气分析状况良好，两组差异无显著性意义。两组患者的并发症发生率、急性排斥反应及死亡率差异均无显著性意义(P>0.05)。麻醉后硬膜外复合全静脉麻醉组单、双肺通气患者的氧耗量、二氧化碳排出量和能量消耗指标均明显高于全静脉麻醉组相同时段对应指标(P<0.05)。同组患者单肺通气的氧耗量、二氧化碳排出量和呼吸商指标低于双肺通气，但差异不明显(P>0.05)。硬膜外复合全静脉麻醉组单、双肺通气患者的去甲肾上腺素、肾上腺素、皮质醇以及血糖水平均明显低于全静脉麻醉组相同时段对应水平(P<0.05)。全静脉麻醉组麻醉后双肺通气患者的皮质醇激素水平明显高于单肺通气患者(P<0.05)。硬膜外复合全静脉麻醉组患者去甲肾上腺素、肾上腺素、皮质醇以及血糖水平在单、双肺通气时的差异不明显(P>0.05)。提示在双肺移植过程中，胸段硬膜外复合全静脉麻醉与全静脉麻醉相比，患者氧耗量、二氧化碳排出量和能量代谢明显增强，可减轻应激反应，且麻醉后代谢、应激情况不受通气方式影响。
揹景：在非體外循環的條件下，保證患者在痳醉效果良好的情況下完成序貫式雙肺移植，胸段硬膜外複閤全靜脈痳醉和全靜脈痳醉的選擇上尚存在爭議。<br> 目的：觀察序貫式雙肺移植過程中兩種不同的痳醉方式對患者呼吸功能及肺生物學功能的影響。<br> 方法：將24例序貫式雙肺移植患者分為全靜脈痳醉組及硬膜外複閤全靜脈痳醉組。對兩組患者痳醉後單、雙肺通氣10 min後的氧耗量、二氧化碳排齣量、呼吸商和能量消耗進行測定。同時，對比分析兩組患者移植過程中去甲腎上腺素、腎上腺素、皮質醇以及血糖水平參數變化。<br> 結果與結論：兩組患者在移植後6箇月、1年及3年的隨訪調查中，肺功能均得到明顯的改善，血氣分析狀況良好，兩組差異無顯著性意義。兩組患者的併髮癥髮生率、急性排斥反應及死亡率差異均無顯著性意義(P>0.05)。痳醉後硬膜外複閤全靜脈痳醉組單、雙肺通氣患者的氧耗量、二氧化碳排齣量和能量消耗指標均明顯高于全靜脈痳醉組相同時段對應指標(P<0.05)。同組患者單肺通氣的氧耗量、二氧化碳排齣量和呼吸商指標低于雙肺通氣，但差異不明顯(P>0.05)。硬膜外複閤全靜脈痳醉組單、雙肺通氣患者的去甲腎上腺素、腎上腺素、皮質醇以及血糖水平均明顯低于全靜脈痳醉組相同時段對應水平(P<0.05)。全靜脈痳醉組痳醉後雙肺通氣患者的皮質醇激素水平明顯高于單肺通氣患者(P<0.05)。硬膜外複閤全靜脈痳醉組患者去甲腎上腺素、腎上腺素、皮質醇以及血糖水平在單、雙肺通氣時的差異不明顯(P>0.05)。提示在雙肺移植過程中，胸段硬膜外複閤全靜脈痳醉與全靜脈痳醉相比，患者氧耗量、二氧化碳排齣量和能量代謝明顯增彊，可減輕應激反應，且痳醉後代謝、應激情況不受通氣方式影響。
배경：재비체외순배적조건하，보증환자재마취효과량호적정황하완성서관식쌍폐이식，흉단경막외복합전정맥마취화전정맥마취적선택상상존재쟁의。<br> 목적：관찰서관식쌍폐이식과정중량충불동적마취방식대환자호흡공능급폐생물학공능적영향。<br> 방법：장24례서관식쌍폐이식환자분위전정맥마취조급경막외복합전정맥마취조。대량조환자마취후단、쌍폐통기10 min후적양모량、이양화탄배출량、호흡상화능량소모진행측정。동시，대비분석량조환자이식과정중거갑신상선소、신상선소、피질순이급혈당수평삼수변화。<br> 결과여결론：량조환자재이식후6개월、1년급3년적수방조사중，폐공능균득도명현적개선，혈기분석상황량호，량조차이무현저성의의。량조환자적병발증발생솔、급성배척반응급사망솔차이균무현저성의의(P>0.05)。마취후경막외복합전정맥마취조단、쌍폐통기환자적양모량、이양화탄배출량화능량소모지표균명현고우전정맥마취조상동시단대응지표(P<0.05)。동조환자단폐통기적양모량、이양화탄배출량화호흡상지표저우쌍폐통기，단차이불명현(P>0.05)。경막외복합전정맥마취조단、쌍폐통기환자적거갑신상선소、신상선소、피질순이급혈당수평균명현저우전정맥마취조상동시단대응수평(P<0.05)。전정맥마취조마취후쌍폐통기환자적피질순격소수평명현고우단폐통기환자(P<0.05)。경막외복합전정맥마취조환자거갑신상선소、신상선소、피질순이급혈당수평재단、쌍폐통기시적차이불명현(P>0.05)。제시재쌍폐이식과정중，흉단경막외복합전정맥마취여전정맥마취상비，환자양모량、이양화탄배출량화능량대사명현증강，가감경응격반응，차마취후대사、응격정황불수통기방식영향。
BACKGROUND:In the non-extracorporeal circulation conditions, the choice of thoracic general-epidural anesthesia plus intravenous anesthesia and intravenous anesthesia alone is stil controversial for sequential double lung transplantation. <br> OBJECTIVE:To investigate the influence of two different anesthetic methods on the respiratory function and lung biological function of the patients after treated with sequential double lung transplantation. <br> METHODS:The 24 patients undergoing sequential double lung transplantation were randomly divided into two groups:general anesthesia group and general anesthesia combined general-epidural anesthesia group, with 12 patients in each group. Al the patients were anesthetized and were subjected to one-lung or bilateral-lung ventilations for 10 minutes. Then oxygen consumption, carbon dioxide emission, respiratory quotient and energy expenditure were measured during ventilation. At the same time, the secretion of norepinephrine, epinephrine, cortisol and glucose levels were analyzed. <br> RESULTS AND CONCLUSION:At 6 months, 1 year and 3 years after transplantation, the lung functions of patients in both groups were significantly improved, blood gas analysis was normal, and there was no significant difference between the two groups. The incidence of complications, acute rejection, and mortality in the two groups showed no significantly difference (P>0.05). In general anesthesia combined general-epidural anesthesia group, the oxygen consumption, carbon dioxide emission and energy expenditure were significantly higher than those of general anesthesia group (P<0.05). But the secretion of oxygen consumption, carbon dioxide emission and respiratory quotient in the same group were lower during one-lung-ventilation than that during bilateral-lung-ventilation, without significant differences (P>0.05). The secretion of norepinephrine, epinephrine, cortisol and glucose levels were significantly elevated in general anesthesia combined general-epidural anesthesia group, when compared to general anesthesia group (P<0.05). In the general anesthesia group, the secretion of cortisol during bilateral-lung-ventilation was significantly higher than that of one-lung-ventilation (P<0.05). There was no significant difference in the norepinephrine, epinephrine, cortisol and glucose levels during one-lung-ventilation and bilateral-lung-ventilation in general anesthesia combined general-epidural anesthesia group (P>0.05). In the lung transplantation process, general anesthesia combined general-epidural anesthesia increases the secretion of oxygen consumption, carbon dioxide emission, and energy expenditure, reduces stress reaction, compared with general anesthesia. In addition, the metabolism and stress are not mediated by the way of ventilation.
