麻醉方式对序贯式双肺移植患者呼吸功能及肺功能的影响  

Effect of anesthetic methods on respiratory and lung functions of patients after sequential double lung transplantation

作　　者：黄乐林[1] 

机构地区：[1]解放军第171医院麻醉科,江西省九江市332000

出　　处：《中国组织工程研究》2014年第27期4304-4309,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在非体外循环的条件下,保证患者在麻醉效果良好的情况下完成序贯式双肺移植,胸段硬膜外复合全静脉麻醉和全静脉麻醉的选择上尚存在争议。目的:观察序贯式双肺移植过程中两种不同的麻醉方式对患者呼吸功能及肺生物学功能的影响。方法:将24例序贯式双肺移植患者分为全静脉麻醉组及硬膜外复合全静脉麻醉组。对两组患者麻醉后单、双肺通气10 min后的氧耗量、二氧化碳排出量、呼吸商和能量消耗进行测定。同时,对比分析两组患者移植过程中去甲肾上腺素、肾上腺素、皮质醇以及血糖水平参数变化。结果与结论:两组患者在移植后6个月、1年及3年的随访调查中,肺功能均得到明显的改善,血气分析状况良好,两组差异无显著性意义。两组患者的并发症发生率、急性排斥反应及死亡率差异均无显著性意义(P>0.05)。麻醉后硬膜外复合全静脉麻醉组单、双肺通气患者的氧耗量、二氧化碳排出量和能量消耗指标均明显高于全静脉麻醉组相同时段对应指标(P<0.05)。同组患者单肺通气的氧耗量、二氧化碳排出量和呼吸商指标低于双肺通气,但差异不明显(P>0.05)。硬膜外复合全静脉麻醉组单、双肺通气患者的去甲肾上腺素、肾上腺素、皮质醇以及血糖水平均明显低于全静脉麻醉组相同时段对应水平(P<0.05)。全静脉麻醉组麻醉后双肺通气患者的皮质醇激素水平明显高于单肺通气患者(P<0.05)。硬膜外复合全静脉麻醉组患者去甲肾上腺素、肾上腺素、皮质醇以及血糖水平在单、双肺通气时的差异不明显(P>0.05)。提示在双肺移植过程中,胸段硬膜外复合全静脉麻醉与全静脉麻醉相比,患者氧耗量、二氧化碳排出量和能量代谢明显增强,可减轻应激反应,且麻醉后代谢、应激情况不受通气方式影响。BACKGROUND：In the non-extracorporeal circulation conditions, the choice of thoracic general-epidural anesthesia plus intravenous anesthesia and intravenous anesthesia alone is stil controversial for sequential double lung transplantation. OBJECTIVE：To investigate the influence of two different anesthetic methods on the respiratory function and lung biological function of the patients after treated with sequential double lung transplantation. METHODS：The 24 patients undergoing sequential double lung transplantation were randomly divided into two groups：general anesthesia group and general anesthesia combined general-epidural anesthesia group, with 12 patients in each group. Al the patients were anesthetized and were subjected to one-lung or bilateral-lung ventilations for 10 minutes. Then oxygen consumption, carbon dioxide emission, respiratory quotient and energy expenditure were measured during ventilation. At the same time, the secretion of norepinephrine, epinephrine, cortisol and glucose levels were analyzed. RESULTS AND CONCLUSION：At 6 months, 1 year and 3 years after transplantation, the lung functions of patients in both groups were significantly improved, blood gas analysis was normal, and there was no significant difference between the two groups. The incidence of complications, acute rejection, and mortality in the two groups showed no significantly difference （P〉0.05）. In general anesthesia combined general-epidural anesthesia group, the oxygen consumption, carbon dioxide emission and energy expenditure were significantly higher than those of general anesthesia group （P〈0.05）. But the secretion of oxygen consumption, carbon dioxide emission and respiratory quotient in the same group were lower during one-lung-ventilation than that during bilateral-lung-ventilation, without significant differences （P〉0.05）. The secretion of norepinephrine, epinephrine, cortisol and glucose levels were significantly elevated in general anesthesia combined general-epidural anesthesia group,

关 键 词：组织构建 移植 肺移植 麻醉 应激 能量代谢 全静脉麻醉 硬膜外麻醉 肺功能 血气分析 

分 类 号：R318[医药卫生—生物医学工程]