高渗氯化钠对单肺通气肺的病理学影响  

Pathology effect of hypertonic sodium chloride on one-lung ventilation

作　　者：黎旭[1] 金涛[1] 奉孝荣 

机构地区：[1]四川省遂宁市第一人民医院,四川遂宁629000

出　　处：《现代中西医结合杂志》2012年第31期3427-3428,3431,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨高渗氯化钠对单肺通气患者的病理学影响。方法选择拟单肺通气剖胸手术ASAⅠ～Ⅱ级的患者60例,随机分为高渗氯化钠治疗组(H组)和对照组(C组),每组30例。在单肺通气30 min时经中心静脉导管输注7.5%氯化钠溶液(H组)或生理盐水(C组)2 mL/kg。观察开始进行单肺通气(T1)、单肺通气30 min(T2)、输注完成后30 min(T3)、输注后60 min(T4)、单肺通气结束(T5)5个时点的动态肺顺应性(Cdyn)、气道峰压(Ppeak)、气道平均压(Pmean)、动脉血氧分压(p(O2))、血清Na+浓度,并于T1、T5时各取肺组织1块,切片染色高倍镜下观察。结果 2组患者T1与T2时间段比较,Cdyn、p(O2)明显降低,Ppeak、Pmean明显升高。H组T3、T4、T5与T2比较,Cdyn、p(O2)逐渐升高,Ppeak、Pmean逐渐下降,且H组T3、T4、T5的Cdyn、p(O2)明显高于C组,Ppeak明显低于C组,H组T4、T5的Pmean明显低于C组。而C组患者T3、T4、T5的Cdyn、Ppeak、Pmean、p(O2)与T2比较无显著性差异。切片观察到H组出现肺组织病理学改变的明显少于C组。结论 7.5%氯化钠溶液对单肺通气患者的各呼吸力学参数有改善作用,能明显减少肺组织损伤,对肺通气功能具有保护作用。Objective It is to explore the effect of hypertonic sodium chloride on pathology in. Methods 60 patients with ASA Ⅰ - Ⅱ level undergoing one-lung ventilation thoracotomy were randomly divided into hypertonic saline treatment group （group H） and control group （group C） , 30 eases in each one. In the first one-lung ventilation via central venous catheter at 30 min infusion of 7.5% sodium chloride solution （ group H） or saline （group C） 2 mL/kg. Dynamic lung compliance （Cdyn） , peak airway pressure （Ppeak） , mean airway pressure （Pmean） , arterial oxygen pressure （p（ O2 ）） , serum Na ＋ concentration were observed at five points in time which were begin one-lung ventilation （ T1 ）, one-lung ventilation section 30 min （ T2 ） , after the first infusion 30 min （ T3 ） , after infusion 60 min （ T4 ） , the end of one-lung ventilation （ T5 ） , and in T1, T5 lung tissue from each piece of stained sections were observed under high-powered microscope. Results Cdyn, p（ O2 ） decreased and Ppeak, Pmean significantly increased at T1 and T2 in both groups（P 〈0.05）. Cdyn, p（ O2 ） increased gradually and Ppeak, Pmean significantly decreased at T3, T4 and T5 compared with that at T2 in group H, and Cdyn, p（ O2 ） were obviously higher and Ppeak was significantly lower at T3 , T4 and T5 in group H compared with that in group C. Pmean was lower at T4 and T5 in group H than that in group C. Compared with that at T2, no significant difference in Cdyn, Ppeak, Pmean, p（O2） at T3, T4 and Ts in group C was found. Pathology changes of lung tissue in group H were less than that in group C. Conclusion 7.5% sodium chloride solution has improving effect on various respiratory mechanics parameters in onelung ventilation patients, and can significantly reduce lung injury and has protective function on pulmonary function.

关 键 词：高渗氯化钠 单肺通气 病理学 

分 类 号：R614[医药卫生—麻醉学]