术中保温对肺癌根治术患者中性粒细胞呼吸爆发的影响  

Effects of intraoperative thermostasis on respiratory burst of pulymorphonuclear neutrophil in patients undergoing radical operation for lung cancer

作　　者：姚允泰[1] 刘定华[2] 赵晶[1] 龚志毅[1] 罗爱伦[1] 肖涵[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院麻醉科,100730 [2]中国医学科学院中国协和医科大学北京协和医院检验科,100730

出　　处：《中华麻醉学杂志》2007年第7期581-584,共4页Chinese Journal of Anesthesiology

摘　　要：目的探讨术中保温对肺癌根治术患者中性粒细胞（PMNs）呼吸爆发的影响。方法32例全麻下行肺癌根治术患者，ASAⅡ或Ⅲ级，随机分为2组（n=16）：对照组（C组）和保温组（W组）。C组术中仅以毛毯等常规保温措施保温；W组还使用加温毯和输液加温器保温，以维持术中核心体温不低于基础值。静脉注射芬太尼、咪达唑仑、异丙酚和罗库溴铵行麻醉诱导后气管插管，术中吸入异氟醚和氧化亚氮维持麻醉。于术前（基础值）、术中（关胸前冲洗胸腔后即刻）和术毕（缝皮结束）采集外周静脉血，测定血常规、PMNs活化率及其活性氧（ROS）产量。结果与术前相比，2组术中和术毕时WBC计数及PMNs百分比均升高（P〈0．05），2组间WBC计数和PMNs百分比差异无统计学意义。在刺激状态下（加入佛波酯）：与术前相比，2组术中、术毕时PMNs活化率均升高，W组术毕时ROS产量升高（P〈0．05），W组术毕时ROS产量高于C组（P〈0．05）；在静态下（加入磷酸盐缓冲液）：与术前相比，C组术中PMNs活化率和术中、术毕时ROS产量均降低（P〈0．05），W组术中PMNs活化率、术中及术毕ROS产量均高于C组（P〈0．05）。结论肺癌根治术中保温可保持静态下活化PMNs的数量和ROS产量，并增强刺激状态下PMNs的ROS产量，但对活化的PMNs数量无影响。Objective To investigate the influence of intraoperative thermostasis over respiratory burst of polymorphonuclear neutrophils （PMNs） in patients undergoing radical operation for lung cancer. Methods Thirty- two ASA Ⅱ or Ⅲ patients scheduled for radical operation for lung cancer performed under general anesthesia were randomized into 2 groups （n = 16 each）： control group （C） and warming group （W）. The patients were kept warm by force-air warming system and fluid warming device as soon as the patients were admitted to the operation room in group W. Rectal and axillary temperature were continuously monitored as core and surface temperature. Core temperature was maintained at preoperative level （baseline）. Anesthesia was induced with midazolam, fentanyl and prepefol. Tracheal intubation was facilitated with rocuronium. Anesthesia was maintained with isoflurane and nitroas oxide and intermittent i.v. boluses of fentanyl, midazolam and vecuronium. Venous blood samples were obtained before, during and at the end of surgery for normal blood analysis and respiratory burst of PMNs which included activated PMNs count and reactive oxygen species （ROS） production. Results （ 1 ） WBC and PMN counts were significantly increased during and after operation as compared with the baseline values before operation in both groups and there was no significant difference in WBC and PMN counts between the two groups. （2） PMA stimulation resulted in higher intraoperative and postoperative activated PMN count in both groups and higher postoperative ROS production in group W. Postoperative ROS production was significantly higher in group W than in group C. （3） Without stimulation activated PMN count during operation and intra- and post-operative ROS production were significantly decreased as compared with the baseline values before operation in group C, while in group W there was no significant difference in pre-, intra- and post-operative activated PMN counts and ROS production. The intraoperative PM

关 键 词：体温 中性白细胞 呼吸爆发 肺切除术 肺肿瘤 

分 类 号：R686[医药卫生—骨科学]