国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2015年
5期
398-403
,共6页
吴志云%查本俊%王永盛%谢平%庄海滨
吳誌雲%查本俊%王永盛%謝平%莊海濱
오지운%사본준%왕영성%사평%장해빈
丙泊酚%七氟醚%单肺通气%肺内分流%炎性因子
丙泊酚%七氟醚%單肺通氣%肺內分流%炎性因子
병박분%칠불미%단폐통기%폐내분류%염성인자
Propofol%Sevoflurane%One-lung ventilation%Intrapulmonary shunt%Inflammatory cytokines
目的 比较单肺通气过程中,七氟醚和丙泊酚对实施小潮气量联合低呼气末正压通气(positive end-expiratorypressure,PEEP)患者肺内分流、氧合和炎性因子的影响.方法 择期行右侧开胸手术的食管癌患者76例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,采用随机数字表法将患者分为丙泊酚组(P组)和七氟醚组(S组),每组38例.P组持续输注丙泊酚,S组持续吸入七氟醚,维持脑电双频指数(bispectal index,BIS)40～50,其他用药两组相同.分别在手术开始前(T0)和单肺通气后30(T1)、60(T2)、90 min(T3)以及膨肺后双肺通气30(T4)、60 min(T5),采集颈内静脉和桡动脉血样进行血气分析,计算肺内分流率(Qs/Qt)、相邻两个时间点动脉血氧分压(arterial partial pressure of oxygen,PaO2)和Qs/Qt的变化值(△PaO2和△Qs/Qt),并测定白细胞介素(interleukin,IL)-8、IL-10和肿瘤坏死因子(tumor necrosis factor,TNF)-α的浓度.结果 与T0比较:两组T1～T5时Qs/Qt、IL-8、IL-10、TNF-α均升高,PaO2降低(P＜0.05).与T1比较:两组T4、T5时PaO2明显升高,Qs/Qt明显降低(P＜0.05);P组IL-8、IL-10、TNF-α在T3～T5时升高,而S组在T2～T5时升高(P＜0.05).两组间比较:△PaO2[P组(-1.3±7.7)、(-1.9±6.0),S组(-4.3±4.3)、(-3.1±5.3)]和△Qs/Qt[P组(0.06-±0.57)、(0.07±0.34),S组(0.71±0.86)、(0.72±0.95)]在T1～T2、T2～T3时间段比较差异均有统计学意义(P＜0.05),S组IL-8、IL-10、TNF-α在T2～T5时均高于P组(P＜0.05).结论 单肺通气期间实施小潮气量联合低PEEP时,丙泊酚比七氟醚对肺内分流和氧合影响更小,产生炎性因子少.
目的 比較單肺通氣過程中,七氟醚和丙泊酚對實施小潮氣量聯閤低呼氣末正壓通氣(positive end-expiratorypressure,PEEP)患者肺內分流、氧閤和炎性因子的影響.方法 擇期行右側開胸手術的食管癌患者76例,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅲ級,採用隨機數字錶法將患者分為丙泊酚組(P組)和七氟醚組(S組),每組38例.P組持續輸註丙泊酚,S組持續吸入七氟醚,維持腦電雙頻指數(bispectal index,BIS)40～50,其他用藥兩組相同.分彆在手術開始前(T0)和單肺通氣後30(T1)、60(T2)、90 min(T3)以及膨肺後雙肺通氣30(T4)、60 min(T5),採集頸內靜脈和橈動脈血樣進行血氣分析,計算肺內分流率(Qs/Qt)、相鄰兩箇時間點動脈血氧分壓(arterial partial pressure of oxygen,PaO2)和Qs/Qt的變化值(△PaO2和△Qs/Qt),併測定白細胞介素(interleukin,IL)-8、IL-10和腫瘤壞死因子(tumor necrosis factor,TNF)-α的濃度.結果 與T0比較:兩組T1～T5時Qs/Qt、IL-8、IL-10、TNF-α均升高,PaO2降低(P＜0.05).與T1比較:兩組T4、T5時PaO2明顯升高,Qs/Qt明顯降低(P＜0.05);P組IL-8、IL-10、TNF-α在T3～T5時升高,而S組在T2～T5時升高(P＜0.05).兩組間比較:△PaO2[P組(-1.3±7.7)、(-1.9±6.0),S組(-4.3±4.3)、(-3.1±5.3)]和△Qs/Qt[P組(0.06-±0.57)、(0.07±0.34),S組(0.71±0.86)、(0.72±0.95)]在T1～T2、T2～T3時間段比較差異均有統計學意義(P＜0.05),S組IL-8、IL-10、TNF-α在T2～T5時均高于P組(P＜0.05).結論 單肺通氣期間實施小潮氣量聯閤低PEEP時,丙泊酚比七氟醚對肺內分流和氧閤影響更小,產生炎性因子少.
목적 비교단폐통기과정중,칠불미화병박분대실시소조기량연합저호기말정압통기(positive end-expiratorypressure,PEEP)환자폐내분류、양합화염성인자적영향.방법 택기행우측개흉수술적식관암환자76례,미국마취의사협회(ASA)분급Ⅰ～Ⅲ급,채용수궤수자표법장환자분위병박분조(P조)화칠불미조(S조),매조38례.P조지속수주병박분,S조지속흡입칠불미,유지뇌전쌍빈지수(bispectal index,BIS)40～50,기타용약량조상동.분별재수술개시전(T0)화단폐통기후30(T1)、60(T2)、90 min(T3)이급팽폐후쌍폐통기30(T4)、60 min(T5),채집경내정맥화뇨동맥혈양진행혈기분석,계산폐내분류솔(Qs/Qt)、상린량개시간점동맥혈양분압(arterial partial pressure of oxygen,PaO2)화Qs/Qt적변화치(△PaO2화△Qs/Qt),병측정백세포개소(interleukin,IL)-8、IL-10화종류배사인자(tumor necrosis factor,TNF)-α적농도.결과 여T0비교:량조T1～T5시Qs/Qt、IL-8、IL-10、TNF-α균승고,PaO2강저(P＜0.05).여T1비교:량조T4、T5시PaO2명현승고,Qs/Qt명현강저(P＜0.05);P조IL-8、IL-10、TNF-α재T3～T5시승고,이S조재T2～T5시승고(P＜0.05).량조간비교:△PaO2[P조(-1.3±7.7)、(-1.9±6.0),S조(-4.3±4.3)、(-3.1±5.3)]화△Qs/Qt[P조(0.06-±0.57)、(0.07±0.34),S조(0.71±0.86)、(0.72±0.95)]재T1～T2、T2～T3시간단비교차이균유통계학의의(P＜0.05),S조IL-8、IL-10、TNF-α재T2～T5시균고우P조(P＜0.05).결론 단폐통기기간실시소조기량연합저PEEP시,병박분비칠불미대폐내분류화양합영향경소,산생염성인자소.
Objective To compare the effects of sevoflurane and propofol anesthesia on intrapulmonary shunt,oxygenation and inflammatory cytokines in small tidal volume combined with low positive end-expiratory pressure (PEEP) during one-lung ventilation.Methods Seventy-six ASA Ⅰ-Ⅲ patients undergoing elective esophagus cancer resection via right thoracotomy.Using a random number sequence,patients were divided into two groups (n=38):propofol group (group P) and sevoflurane group (group S).Propofol infusion in the group P and sevoflurane inhalation in the group S maintained a bispectal index (BIS) at 40-50 during the operation.The other drugs were same in the two groups.Blood samples were taken simultaneously from radial artery and jugular venous for measurement of blood gases and calculation of intrapulmonary shunt (Qs/Qt),and the blood concentrations of interleukin (IL)-8,IL-10,tumor necrosis factor(TNF)-α were measured before operation (T0),and at 30(T1),60(T2),90 min(T3) after one-lung ventilation,and at 30 (T4),60 min (T5) after two-lung ventilation.In addition,the values of arterial partial pressure of oxygen (PaO2),Qs/Qt between two time points(△PaO2,△Qs/Qt) were also calculated.Results Compare with that at T0,the Qs/Qt,TNF-α,IL-8 and IL-10 increased significantly,while the PaO2 decreased significantly at T1-T5 in the two groups (P＜0.05).Compare with that at T1,the PaO2 increased significantly and the Qs/Qt decreased significantly at T4,T5 in the two groups (P＜0.05),the IL-8,IL-10 and TNF-α increased significantly at T3-T5 in the P group and decreased significantly at T2-T5 in the group S(P＜0.05).The △PaO2[group P (-1.3±7.7),(-1.9±6.0),group S(-4.3±4.3),(-3.1±5.3)],the △Qs/Qt [group P(0.06±0.57),(0.07±0.34),group S(0.71±0.86),(0.72±0.95)] in the T1-T2,T2-T3,and the IL-8,IL-10,TNF-α at T2-T5 were significantly different between the P and S groups (P＜0.05).Conclusions Compared with sevoflurane,propofol has less influence on intrapulmonary shunt,oxygenation,and inflammatory cytokines undergoing the small tidal volume combined with low PEEP during one-lung ventilation.
