单肺通气前氯胺酮经单肺或双肺雾化吸入肺保护的研究  

Ketamine inhalation via single or two lung before one-lung ventilation for perioperative lung protection in thoracic surgery patients

作　　者：王丽君[1] 蒋大明[1] 许仄平[1] 万梅方[1] 鲁振[1] 顾连兵[1] 

机构地区：[1]江苏省肿瘤医院麻醉科,南京市210009

出　　处：《临床麻醉学杂志》2014年第1期10-13,共4页Journal of Clinical Anesthesiology

基　　金：江苏省自然科学基金资助项目(BK2010588)

摘　　要：目的 比较单肺通气（OLV）前氯胺酮经左单肺（OLV期间非通气侧肺）雾化或双肺雾化吸人的肺保护作用.方法 择期行经左胸食管中段癌根治术患者60例,ASA Ⅰ或Ⅱ级,随机均分为两组：氯胺酮单肺雾化组（K1组）,氯胺酮双肺雾化组（K2组）.静脉全麻双腔支气管插管后,K1组给予氯胺酮经左单肺雾化吸入（氯胺酮用量为1 mg/kg,用生理盐水稀释至10 ml）,K2组给予氯胺酮经双肺雾化吸人（氯胺酮用量同K1组）.分别于雾化吸人前（T1）、OLV 30 min（T2）、OLV 60min（T3）、OLV 120 min（T4）、OLV结束5 min（T5）、手术结束（T6）时抽取桡动脉血,行动脉血气分析,记录SpO2、PETCO2、气道压（Paw）及血流动力学指标.于T1、T2、手术结束2 h（T7）抽取中心静脉血,检测血中IL-6、IL-8、可溶性细胞间粘附分子-1（sICAM-1）水平.结果 两组患者PaO2水平在T2～T4时明显低于T1时（P＜0.05）,其中K1组在T5时即显著回升至T1时水平,K2组至T5时明显回升,但仍明显低于T1时（P＜0.05）,T6时则较T5时进一步显著回升至T1时水平.两组Paw在T2～T4时明显高于T1时（P＜0.05）.K1组患者T7时的血清IL-6、IL-8、水平明显高于T1时（P＜0.05）,K2组患者T2、T7时的血清IL-6、IL-8、sICAM-1水平明显高于T1时（P＜0.05）;K1组患者T7时的血清IL-6、IL-8、sICAM-1水平明显低于K2组（P＜0.05）.结论 OLV前经单肺（OLV期间非通气侧肺）雾化吸人氯胺酮的肺保护效果优于经双肺雾化吸入氯胺酮;OLV时两侧肺的损伤是不均一的,非通气侧肺的损伤程度重于通气侧肺.Objective To study the effects of ketamine inhalation via single or two lung bdore onelung ventilation（OLV） for perioperative lung protection in thoracic surgery patients.Methods Sixty patients scheduled for dective trans-left-thoracic esophagectomy for esophag eal cancer were randomly and single-blindly located into 2 groups.After intravenous anesthesia with double-lumen endobronchial intubation,patients in each group received different therapy before OLV,as inhaling ketamine 1 mg/kg via left lung（the nondependent lung during OLV） in group K1 and inhaling ketamine 1 mg/kg via two lung in group K2.Arterial blood gas analysis was performed,SpO2,PETCO2,Paw and hemodynamic indicators were recorded at these points：before OLV（T1）,OLV 30 mins（T2）,OLV 1 h（T3）,OLV 2 h（T4）,OLV ended 5 mins（T5）,end of surgery（T6）.Central venous blood was sampled at T1,T2 and 2h after surgery （T7） for the determination of IL-6,IL-8 and sICAM-1 concertration by ELISA.Results PaO2 at T2-T4 were significantly lower than that at T1 in both groups （P〈0.05）.PaO2 at T5 increased significantly to the level of PaO2 at T1 in group K1 （P〈 0.05）; PaO2 increased significantly at T5,but still kept lower than that at T1 in group K2 （P〈0.05）.Compared with T1,Pawat T2-T4 were significantly increased in both groups （P〈0.05）.Serum IL-6,IL-8levels at T7 were significantly higher than those at T1 in group K1（P〈0.05）,serum IL-6,IL-8,sICAM-1levels at T2,T7 in group K2 （P〈0.05） were significantly higher than at T1 （P〈0.05）.IL-6,IL-8 and sICAM1 in group K1 at T7 were lower than those in group K2 （P〈0.05）.Conclusion As for perioperative lug protection in thoracic surgery patients,inhalation of ketamine before OLV via one lung is more effective than that via two lungs.So the injury of lung during OLV was inhomogeneous,which was because the injury in the non-dependent lung was more severe than the other one .

关 键 词：氯胺酮 食管癌 单肺通气 超声雾化吸入 

分 类 号：R614[医药卫生—麻醉学]