七氟烷预先吸入对单肺通气患者肺功能及氧化应激的影响

Influences of sevoflurane inhalation in advance on pulmonary function and oxidative stress responses during one-lung ventilation

摘要:

目的：探讨七氟烷预先吸入对食管癌患者单肺通气（one lung ventilation，OLV）期间肺功能及氧化应激的影响。方法：60例拟行食管癌切除术患者，随机分为七氟烷预先吸入组（SP组）、丙泊酚静脉组（P组）及七氟烷全程吸入组（S组）。3组患者全麻诱导均为静脉注射咪达唑仑0.04 mg/kg，芬太尼3~4 μg/kg，靶控输注丙泊酚血浆靶浓度3 μg/ml，静脉注射罗库溴铵0.6~0.8 mg/kg，插入双腔管后SP组以七氟烷预先吸入维持麻醉至OLV前，OLV后与P组相同，采用丙泊酚、瑞芬太尼维持麻醉，七氟烷全程吸入组全程七氟烷吸入维持麻醉。麻醉诱导后（T1）、OLV开始前（T2）、OLV 30 min（T3）、OLV 60 min（T4）、OLV结束前（T5）及术毕（T6） 共6个时间点，采集桡动脉血和右心房血进行血气分析，计算Qs/Qt值，于T1、T3~T6时取右心房血样，测定血清超氧化物歧化酶（superoxide dismutase，SOD）活性和丙二醛（malondialdehyde，MDA）的浓度，同时记录血流动力学指标以及相关的临床数据。结果：与T1时比较，T3～T5（OLV期间），3组Qs/Qt有明显增高（P<0.01），PaO2明显降低（P<0.01），T3～T6时血清SOD活性降低（P<0.05），MDA浓度升高（P<0.05）；组间比较：与P组、S组相比，SP组在T4时Qs/Qt降低（P<0.05），T5时血清SOD活性升高、MDA浓度降低（P<0.05）；S组与P组相比，S组在T3时Qs/Qt降低（P<0.05），T5时Qs /Qt增加（P<0.05），T3～T6时血清SOD活性稍降低，MDA浓度稍升高，但无统计学差异（P >0.05）；PaO2在3组各对应时点比较差异无统计学意义（P >0.05）。结论：OLV前用七氟烷预先吸入可降低食管癌患者OLV的肺内分流率，减轻OLV的氧化应激反应，对氧分压无明显改善。

Abstract:

Objective：To observe the effects of sevoflurane inhalation in advance on pulmonary function and oxidative stress responses during one-lung ventilation（OLV）. Methods：Sixty patients preparing to undergo radical esophageal cancer resection were randomly divided into 3 groups equally（n=20）：sevoflurane inhalation in advance group（group SP）；propofol group（group P）；sevoflurane group（group S）. Anesthesia was induced with midazolan 0.04 mg/kg，fentanyl 3-4 μg/kg and propofol was administered by target con－trolled infusion with target blood concertration of 3 μg/ml. Tracheal intubation was facilitated with rocuronium of 0.6-0.8 mg/kg. Anesthesia was maintained with propofol at a target blood concertration of 3 μg/ml in group P or inhalation of sevoflurane（1.0%-3.0%） in group S. Anesthesia was maintained with the inhalation of sevoflurane（1.0%-2.0%） before OLV and with propofol after OLV in group SP. Remifentanil was infused by target controlled and atracurium was given intravenously and intermittently during op－eration in each groups. Bispectral index was maintained at 40-60. Blood samples were taken from radial artery and right atrial blood at 6 time points：after the induction of anesthesia（baseline，T1），before OLV（T2），at 30 min（T3），60 min（T4） after OLV，before the end of OLV（T5） and after operation（T6） to measure blood gases and to calculate Qs/Qt. Serum malondialdehyde（MDA） concen－trations and superoxide dismutase（SOD） activity were measured at T1，T3-T5. Results：Qs/Qt and MDA concentrations were significantly higher while PaO2、SOD activity were significantly lower during operation（from T3 to T5） compared with those at T1 in three groups（P<0.01）. Qs/Qt at T4 and MDA at T5 were significantly lower while SOD was significantly higher in SP group than in group P and group S（P<0.05）. Qs/Qt was significantly lower at T3 while was significantly higher at T5 in group S than in group P. There was no differ－ence in PaO2 among the three groups. Conclusions：Sevoflurane inhalation in advance before OLV could reduce intrapulmonary shunt and oxidative stress during OLV in patients undergoing esoph-ageal cancer resection.