七氟烷对单肺通气肺损伤的保护作用及其机制  

The protective effect of sevoflurane on lung injury induced by one-lung ventilation and its mechanism

作　　者：金晶星[1] 李元海[1] 陈珂[1] 钟薇薇[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022

出　　处：《安徽医科大学学报》2012年第4期446-449,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的探讨七氟烷对单肺通气肺损伤的保护作用及其可能机制。方法择期行肺癌根治术患者61例,ASAⅡ～Ⅲ级,随机分为两组:对照组(Ⅰ组,n=29),七氟烷组(Ⅱ组,n=32);两组采用相同的麻醉诱导方式,气管插管后,I组用全凭静脉维持麻醉,Ⅱ组用七氟烷全程吸入维持麻醉。所有患者分别于插管即刻(T1)、单肺通气90 min(T2)、术毕双肺通气30 min(T3),3个时间点分别测定血浆中白介素8(IL-8)、肿瘤坏死因子-α(TNF-α)含量、动脉血气及测定肺组织水通道蛋白1(AQP1)、水通道蛋白4(AQP4)表达,观察肺组织病理改变。结果与T1时比较,T2、T3时各组血浆中IL-8、TNF-α均明显增高(P<0.01),两组在T3时比较差异有显著性(P<0.05);与T1比较,T2氧合指数明显下降(P<0.05),两组在T3时比较差异有显著性(P<0.05);两组在T1时肺组织AQP1和AQP4表达均差异无显著性;与T1时比较,T2时Ⅰ组AQP1和AQP4表达显著降低(P<0.05),Ⅱ组变化不明显。结论七氟烷对单肺通气所致的肺损伤有保护作用,其机制可能通过降低血浆中IL-8和TNF-α水平及上调肺组织中AQP1和AQP4的表达。Objective To evaluate the effect of sevoflurane on lung injury induced by one-lung ventilation and its mechanism.Methods 61 patients undergoing lung cancer surgery under one-lung ventiliation were evaluated in this study.The patients were randomly divided into two groups：control group（groupⅠ,n=29）,sevoflurane group（Ⅱ group,n=32）.Two groups were induced by the same way.Anesthesia was maintained with 1%~3% sevoflurane or propofol TCI in two groups.Serum IL-8,TNF-α,oxygenation index levels,the expression of aquaporin 1（AQP1） AQP4 and pathological features of the lung tissue were measured at intubation（T1）,one-lung ventilation 90 min（T2）,two lung ventilation 30 min（T3）.Results Compared with T1,the plasma of IL-8、TNF-a was increased obviously in both groups at T2,T3（P0.05）;Compared with T1,the oxygenation index was declined dramatically at T2,T3（P0.05）;The expression of AQP1 and APQ4 in lung tissue in two groups had no obvious difference;Compared with T1,the expression of AQP1 and APQ4 at T2 reduced dramatically in group Ⅰ（P0.05）.Conclusion Sevoflurane can exert a protective effect on the lung injury result from one-lung ventilation,and its mechanism may be related to reducing the level of IL-8 and TNF-α in blood plasma and up-regulating the expression of AQP1 and AQP4 in lung tissue.

关 键 词：七氟烷 单肺通气 炎性因子 水通道蛋白 氧合指数 

分 类 号：R614[医药卫生—麻醉学] R614.2[医药卫生—外科学]