全身麻醉单肺通气期间氧合状况、肺内分流率和炎性反应的变化  

The changes of arterial oxygenation and inflammatory responses during one-lung ventilation in patients undergoing thoracic surgery

作　　者：李卫霞[1] 刘鲲鹏[1] 李昭[1] 宋洁[1] 曹妍婷[1] 王稳[1] 刘德若[2] 郭永庆[2] 李成辉[1] 

机构地区：[1]中日友好医院麻醉科,北京100029 [2]中日友好医院胸外科,北京100029

出　　处：《中日友好医院学报》2014年第2期71-76,共6页Journal of China-Japan Friendship Hospital

摘　　要：目的：观察胸科手术患者全身麻醉下侧卧位单肺通气（OLV）期间氧合状况、肺内分流率和炎性因子的变化.方法：选择25例ASA分级Ⅰ～Ⅱ级、年龄39～81岁拟在全身麻醉下实施侧卧位OLV的择期胸科手术患者,常规全身麻醉诱导.于麻醉诱导前平卧位吸空气时（T1）,侧卧位后双肺通气（TLV）20min （T2）、OLV后15min（T3）、OLV后30min （T4）、OLV结束时（T5）和保持侧卧位恢复TLV后15min（T6）观察患者血压、心率、血氧饱和度（SpO2）的变化,同时在T2、T3、T4和T5分别抽取桡动脉血和中心静脉血0.5ml进行血气分析,计算肺内分流率（Qs/Qt）;在T2、T4、T5时间点取中心静脉血测定血清中肿瘤坏死因子-α （TNF-α）、白介素-6（IL-6）、IL-8和IL-10的浓度.结果：与T1相比,T2～T5时SpO2降低,T4时显著下降（P＜0.05）,T6时SpO2显著高于T2.与T2相比,T3～T5的PaO2显著降低,T5时PaO2显著高于T3和T4;与T2相比,T3、T4的Qs/Qt显著增加,T5时显著低于T3和T4.无一例患者出现SpO2＜90％、临时改双肺通气、或通气侧肺加用PEEP等情况.与T2相比,OLV结束时IL-6、IL-10显著升高,且升高水平与OLV时间正相关.结论：随着OLV时间延长,患者氧合状况和肺内分流率会逐渐改善,炎性因子水平出现不同程度的升高.Objective ：To investigate the arterial oxygenation and inflammatory responses during one-lung ven- tilation （OLV）in lateral decubitns position in patients undergoing thoracic surgery.Methods：We studied 25 adult patients undergoing thoracic surgery with OLV in lateral decubitus position.During OLV,invasive BP, HR,SpO~ and ECG were continuously monitored and recorded at the following time points ：T1 ：Before induction of anesthesia while the patients were supine and breathing room air,T2：20min after two-lung ventilation in lateral decubitus position（LDP）,T3：lSmin after initiation of OLV in LDP,T4：30min after initiation of OLV in LDP,TS：the end of OLV in LDP,and T6：15min after rechanging to TLV in LDP,respectively.Blood samples were taken from radial artery and the internal jungular vein catheter for analysis.Serum tumor necrosis factor- ct （TNF-ct）,interleukin （IL）-6, g, I0 concentration at T2,T4,T5 were analyzed using enzyme hnked immunosor- bent assay（ELISA）.Results：SpO2 at T4 were significantly lower than that of T2,and T6 were significantly in- creased（P〈0.05）.As compared with the values at T2,PaO2 at T3,T4 and T5 were significantly decreased.Intra- pulmonary shunt（Qs/Qt） at T3,T4 were increased significantly and at T5 decreased significantly compared with T3,T4.There was positive correlation between blood levels of IL-6,IL-10 and the length of OLV.Conclusion： Arterial oxygenation and Qs/Qt can improve gradually during one-lung ventilation,the severity of inflammatory responses is correlated with the length of OLV.

关 键 词：单肺通气 氧合 肺内分流率 炎性反应 

分 类 号：R614.27[医药卫生—麻醉学]