七氟醚预处理对肺癌单肺通气患者炎性细胞因子及氧自由基的影响  

Effect of sevoflurane preconditioning on inflammatory cytokines and oxygen radicals during one lung ventilation in patients with lung cancer

作　　者：王东昕[1] 侯文杰[1] 刁世琪 阚红莉 

机构地区：[1]吉林省肿瘤医院麻醉科,长春市130021

出　　处：《临床麻醉学杂志》2013年第9期847-849,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察七氟醚预处理对肺癌单肺通气（OLV）患者炎性细胞因子及氧自由基的影响，探讨七氟醚的肺保护机制。方法选择非小细胞肺癌行肺叶切除患者30例，ASAⅠ或Ⅱ级，随机均分为七氟醚预处理组（S组），对照组（C组）。两组患者全麻诱导后插入双腔管，经纤支镜定位双腔管位置准确，行机械通气。S组OLV前吸入七氟醚30min，行七氟醚预处理，维持1．0的最低肺泡有效浓度（MAC），停用七氟醚快速充氧气气体交换，使OLV前七氟醚吸入浓度为0。C组采用丙泊酚和芬太尼麻醉。两组患者分别于麻醉诱导后（T1）、OLV后30min（T2）、OLV后60min（T3）、术毕（T4）时采集静脉血，测定血清肿瘤坏死因子（TNF-α）、IL-6、IL-8浓度、超氧化物歧化酶（SOD）活性及丙二醛（MDA）浓度。结果与T1时比较，T2～T4时两组TNF-α、IL-6和MDA浓度、T3、T4时两组IL-8浓度明显升高、两组SOD活性明显降低（P〈0．05）。与C组比较，T2～T4时S组TNF-α、IL-6、IL-8和MDA浓度明显降低（P〈0．05或P〈0．01）；T3、T4时S组SOD活性明显升高（P〈0．05）。结论七氟醚预处理可减轻肺癌患者单肺通气时炎性细胞因子的释放，抑制炎症反应，并通过抑制氧自由基的生成，减少脂质过氧化，对单肺通气所致的肺损伤有一定的保护作用。Objective To observe the effect of sevoflurane preconditioning on inflammatory eytokines and oxygen radicals during one lung ventlilation （OLV） in patients with lung cancer and to discuss the mechanism of sevoflurane induced lung protection. Methods Thirty patients, ASA Ⅰ or Ⅱ, with non-small-cell lung cancers underwent pulmonary surgeries were randomized into two groups： sevoflurance preconditioning group （group S, n= 15） and control group （group C, n= 15）. After general anesthesia induction,a double-lumen tube was placed and the position was checked by a fibreoptic bronchoscope. During the mechanical ventilation, patients in group S, received sevoflurance at 1.0 minimum alveolar concentration （MAC） for 30 min as a preconditioning and then replaced by oxygen for a complete rapid gas exchange to reduce the sevoflurane inhalation concentration to 0 before OLV. While in group C, only intravenous anesthetic agents, fentanyl and propofol, were administrated before OLV, Blood concentrations of TNF-a, IL-6, IL-8,SOD and MDA were measured at post-induction of anesthesia（T1 ）, 30 min after OLV in the lateral position（T2）, 60 min after OLV in the lateral position（T3 ）, and at the end of the operation（T4 ）. Results When compared with T1, the concentrations of TNF-α, IL-6 and MDA in both groups and the IL-8 in group S were significantly increased at T2-T4 （P 〈2 0.05）, while the expression of SOD in two groups were decreased significantly （P〈20. 05）. The concentrations of TNF-α, IL-6, IL-8 and MDA in group S were decreased significantly at T2-T4 （P〈20. 05 or P〈0.01） when compared with those in group C. The activity of SOD in group S was significantly increased at T3 and T4 （P 〈2 0.05 ）. Conclusion Sevoflurane preconditioning may moderate the release of inflammatory cytokines to inhibit the inflammatory reaction and may reduce the lipid peroxidation by inhibiting the generation of oxygen free radical. It may protect the lung from the injury during OLV.

关 键 词：七氟醚预处理 细胞因子 氧自由基 单肺通气 

分 类 号：R614[医药卫生—麻醉学]