七氟醚预处理对肺叶切除术患者单肺通气诱导氧化应激损伤的影响  

Effects of sevoflurane preconditioning on the oxidative stress injury induced by one-lung ventilation in patients with pulmonary lobectomy

作　　者：胡凡艳[1] 王公明[1] 张孟元[1] 

机构地区：[1]山东大学附属省立医院麻醉科,济南250021

出　　处：《山东大学学报（医学版）》2012年第7期101-104,共4页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(30872433)

摘　　要：目的观察肺叶切除术患者七氟醚预处理对术侧肺组织血红素氧合酶1(HO-1)表达水平的影响及其肺保护作用。方法择期拟行单纯肺叶切除术患者30名,ASA分级Ⅰ～Ⅱ级,年龄40～60岁,体质量50～75 kg,按照随机数字表法,分为丙泊酚全凭静脉麻醉组(P组)和七氟醚预处理组(S组)。S组单肺通气前吸入1%～2%七氟醚30 min,模拟七氟醚预处理,P组在此阶段采用丙泊酚静脉麻醉作为对照。分别于诱导开始前即刻(T0)、单肺通气前即刻(T1),单肺通气结束前即刻(T2),双肺通气30 min(T3)抽取肘静脉血4 mL,测定血清丙二醛(MDA)的浓度。从切除肺叶取小块正常肺组织,测定肺组织HO-1的含量。术后2 h抽取桡动脉血1 mL,测定肺氧合指数。结果术侧肺叶组织HO-1浓度S组高于P组(P<0.05),T3时刻血清MDA浓度S组低于P组(P<0.05)。术后2 h时肺氧合指数S组高于P组(P<0.05)。结论七氟醚预处理可通过上调肺组织HO-1的表达水平,减轻单肺通气诱导的氧化应激损伤,产生肺保护作用。Objective To observe the effects of sevoflurane preconditioning on the expression of heine oxygenase-1 （HO-1） in the operated lung tissue, and on the lung protection of patients who underwent pulmonary lobectomy. Methods 30 patients, ASA I or 1/, aged 40 to 60 years, weighting 50 to 75 kg, scheduled for pulmonary lobecto- my, were randomly divided into two groups with 15 cases in each group, including propofol all by intravenous anesthe- sia group （group P） and sevoflurane preconditioning group （group S）. In group S, before one-lung ventilation, the pa- tients inhaled 1% to 2% sevoflurane for 30 mins, as a simulation of sevoflurane preconditioning. While in group P, pa- tients were supplied propofol all by intravenous anesthesia in the same period. 4 mL elbow venous blood samples were collected at the beginning of the anesthesia induction （ TO ）, immediately before one-lung ventilation （ T1 ）, immediately at the end of one-lung ventilation （ T2 ）, 30 rains after one-lung ventilation （ T3 ） , respectively, in order to determine the level of serum malondialdehyde （MDA）. The content of heme oxygenase-1 in the normal lung tissue of removal pulmona- ry lobe was detected. 1 mL radial artery blood samples were collected for measuring the oxygenation index （ PaO2/FiO2 ） at 2 h after surgery. Results The content of HO-1 of removal lung tissue was significantly higher in group S than in Group P（ P 〈 0.05 ）. At the time point of T3 , the level of serum MDA was significantly lower in group S than in groupP（P 〈0.05）. At 2 h after surgery, the oxygenation index （PaO2/FiO2 ） was significantly higher in group S than in group P（ P 〈 0.05 ）. Conclusion Sevoflurane preconditioning can play a role in lung protection by up-regulating the expression of HO-1 in lung tissue, and reducing the oxidative stress injury induced by one-lung ventilation.

关 键 词：七氟醚 血红素氧化酶(脱环) 肺功能 肺外科手术 氧化性应激 

分 类 号：R614.27[医药卫生—麻醉学]