不同方式七氟烷处理对胸外科手术单肺通气患者氧化应激水平的影响

Effects of different sevoflurane treatments on level of oxidative stress for thoracic surgery patients with one lung ventilation

摘要:

目的：探讨不同方式七氟烷处理对胸科手术单肺通气（one lung ventilation，OLV）患者氧化应激水平的影响。方法：胸科手术单肺通气患者80例，随机分为4组，即全凭静脉组（P组，丙泊酚及瑞芬太尼维持麻醉）、七氟烷预处理组（S1组，七氟烷吸入30 min后行OLV）、七氟烷后处理组（S2组，OLV后吸入七氟烷）、七氟烷全程吸入组（S3组，全程吸入七氟烷）。分别在麻醉诱导前（T0）、OLV前（七氟烷预处理30 min后）（T1）、OLV结束后30 min（七氟烷后处理30 min）（T2）和24 h（T3）采集桡动脉血。在T1和T2时间点同时取支气管肺泡灌洗液。采用化学比色法测定血清和支气管肺泡灌洗液丙二醛（malondialdehyde，MDA）、超氧化物歧化酶（superoxide dismutase，SOD）、乳酸脱氢酶（lactate dehydrogenase，LDH）、一氧化氮（nitric oxide，NO）含量及活性。结果：在OLV结束后30 min （T2）和24 h（T3），4组患者血清MDA、SOD、LDH、NO水平均较麻醉诱导前（T0）和OLV前（T1）高（P<0.05），而七氟烷各组（S1、S2、S3组）的MDA、LDH、NO水平较全凭静脉组（P组）明显降低，SOD水平则明显增高（P<0.05），S1、S2、S3组间无差异（P>0.05）。在OLV结束后30 min（T2），4组患者支气管肺泡灌洗液中MDA、SOD、LDH、NO水平均较OLV前（T1）高（P<0.05），但七氟烷各组（S1、S2、S3组）的MDA、LDH、NO水平较全凭静脉组（P组）明显降低，SOD水平则明显增强（P<0.05），S1、S2、S3组间无差异（P >0.05）。结论：不同时间七氟烷处理均能降低单肺通气患者血清和支气管肺泡灌洗液 MDA、LDH和NO含量，增强 SOD活性，提示七氟烷具有抗氧化应激损伤作用。

Abstract:

Objective：To study that the effect of different sevoflurane treatments on level of oxidative stress for thoracic surgery pa－tients with one lung ventilation（OLV）. Methods：Totally 80 patients undergoing thoracic surgery with OLV were randomly divided in－to four groups：propofol group（P group），sevoflurane pretreatment group（S1 group），sevoflurane aftertreatment group（S2 group） and sevoflurane whole-treatment group（S3 group）. Anesthesia of four groups was inducted with propofol. In P group，anesthesia was maintained with infusion of propofol and remifentanil. Anesthesia was treated for 30 min before OLV in S1 group and after OLV in S2 group. The patients in S3 group were treated for whole-progressing with 1.0 MAC sevoflurane. Blood samples were taken from radial artery before induction of anesthesia（baseline T0），before OLV（T1），at 30 min after OLV（T2） and at 24 h after OLV（T3）. Meanwhile，bronchoalveolar lavage fluid was taken at T1 and T2. The content or activity of malondialdehyde（MDA），superoxide dismutase（SOD），lactate dehydrogenase（LDH） and nitric oxide（NO） in serum and bronchoalveolar lavage fluid were determined with chemical colori－metric method. Results：The levels or activity of MDA，SOD，LDH and NO in serum in each group were significantly increased at T2 and T3 than at T0 and T1（P<0.05）. But the levels of MDA，LDH and NO were significantly decreased and the activity of SOD were obviously increased in S1-3 groups than in P group（P<0.05），and there was no significant difference among S1，S2 and S3 groups（P >0.05）. After OLV 30 min（T2），the levels or activity of MDA，SOD，LDH and NO in serum in four groups were sig－nificantly increased at T2 and T3，compared with those at T0 and T1（P<0.05）. But the levels of MDA，LDH and NO were significantly decreased and the activity of SOD were obviously increased in S1-3 groups than in P group（P<0.05），and there was no significant dif－ference in S1，S2 and S3 groups（P>0.05）. Conclusion：Different sevoflurane treatments can decrease the content of MDA，LDH and NO，and increase the activity of SOD in serum and bronchoalveolar lavage fluid. The results suggest that sevoflurane possess potential for anti-oxidative stress injuries.