丙泊酚对腹主动脉瘤手术患者的肺保护作用  

Effect of Propofol on Lung Protection in Patients Undergoing Repair of Abdominal Aortic Aneurysm

作　　者：仓静[1] 丁明[1] 薛张纲[1] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国临床医学》2008年第3期409-410,共2页Chinese Journal of Clinical Medicine

摘　　要：目的:研究丙泊酚对肾动脉以下腹主动脉阻断所引起的肺损伤的保护作用。方法:肾动脉以下腹主动脉瘤择期行动脉瘤切除、人造血管替换术的患者20例,ASAⅡ-Ⅲ级,随机分为对照组和丙泊酚组(n=10)。采用硬膜外阻滞复合全身麻醉。分别在腹主动脉阻断前、阻断后5min、再灌注后5min、1h及手术结束时,测定气道峰压(Ppeak)、气道平台压(Pplat)和气道平均压(Pmean),并计算肺动态顺应性(Cdyn=VT/Ppeak)和静态顺应性(Cst=VT/Pplat)。在气管插管后即刻和手术结束时抽血测血浆中SOD活力、MDA含量、LDH活力。结果:阻断后两组患者的Ppleak明显增高(P<0.05),再灌注后虽有降低,但仍高于阻断前,其中对照组增高更为显著(P<0.05);阻断后对照组肺顺应性明显降低,丙泊酚组虽然也有降低,但无显著差异;再灌注后4h,两组患者的肺顺应性有所恢复。与插管即刻相比,丙泊酚组血浆SOD明显增高(P<0.05),并高于对照组的同一时点,有显著差异(P<0.05);手术结束时,丙泊酚组血浆MDA明显低于对照组(P<0.05);对照组血浆LDH虽有所增高,并高于丙泊酚组同一时点,但无显著差异。结论:在肾动脉以下阻断腹主动脉对患者的血流液力学影响明显小于肾动脉以上阻断,阻断部位以下组织器官的缺血及再灌注仍会引起肺损伤;丙泊酚可通过抑制氧自由基的过氧化反应来减轻由主动脉阻断所造成的肺损伤。Objective：To study the effect of Propofol on lung protection in patients undergoing repair of abdominal aortic aneurysm.Methods：20 patients who suffered infrarenal abdominal aortic aneurysm（AAA） were assigned as control group（n=10） or Propofol group（n=10）.All patients received epidural block combined with general anesthesia.Hemodynamic data,blood gas,airway pressure,dynamic and static compliance were measured before,5 min after cross-clamping,5 min after reperfusion,1 h after reperfusion and after operation.The level of SOD,MDA and LDH were determined in plasma.Results：After cross-clamping,the peak airway pressure increased significantly in two groups（P〈0.05）.It decreased slightly,but still higher than normal after reperfusion.After cross-clamp,the lung compliance decreased in two groups,but the control group was lower than the propofol group.With the time of reperfusion,it was back to normal in two groups.At the end of operation,the level of SOD in plasma increased significantly in propofol group than in control group（P〈0.05）.MDA in plasma was lower in propofol group than in control group.In control group,though the level of LDH in plasma were increased at the end of operation,the difference was not significant.Conclusion：Hemodynamic changes were slighter in infrarenal clamping than in suprarenal clamping.The ischemia and reperfusion of the organs and tissue below the level of cross-clampingcaused can lead to lung damage.Propofol may reduce the lung injury by inhibiting the production of oxygen free radical.

关 键 词：丙泊酚 腹主动脉瘤 肺保护 

分 类 号：R971.2[医药卫生—药品]