七氟醚和丙泊酚在小潮气量联合低呼气末正压对单肺通气时肺内分流、氧合和炎性因子的影响比较  

Effects of sevoflurane and propofol anesthesia in small tidal volume combined with low positive end-expiratory pressure on intrapulmonary shunt, oxygenation and inflammatory cytokines during one-lung ventilation

作　　者：吴志云[1] 查本俊[1] 王永盛[1] 谢平[1] 庄海滨[1] 

机构地区：[1]中国人民解放军第一八O医院麻醉科,泉州362000

出　　处：《国际麻醉学与复苏杂志》2015年第5期398-403,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较单肺通气过程中，七氟醚和丙泊酚对实施小潮气量联合低呼气末正压通气（positive end-expiratory pressure, PEEP）患者肺内分流、氧合和炎性因子的影响。方法择期行右侧开胸手术的食管癌患者76例，美国麻醉医师协会（ASA）分级I～Ⅲ级，采用随机数字表法将患者分为丙泊酚组（P组）和七氟醚组（S组），每组38例。P组持续输注丙泊酚，S组持续吸入七氟醚，维持脑电双频指数（bispectal index, BIS）40—50，其他用药两组相同。分别在手术开始前（T0）和单肺通气后30（T1）、60（T2）、90min（B）以及膨肺后双肺通气30（rr4）、60min（T5），采集颈内静脉和桡动脉血样进行血气分析，计算肺内分流率（Qs／Qt）、相邻两个时间点动脉血氧分压（arterial partial pressure of oxygen, PaO2）和Qs／Qt的变化值（GPaO2和AQs／Qt），并测定白细胞介素（interleukin，IL）-8、IL-10和肿瘤坏死因子（tumor necrosis factor，TNF）咀的浓度。结果与R比较：两组T1～T5时Qs／Qt、IL-8、IL-10、TNF-α均升高，PaO2降低（P〈0．05）。与T1比较：两组T4、T5时PaO2明显升高，Qs／Qt明显降低（P〈0．05）；P组IL-8、IL-10、TNF-α在T3-T5时升高，而S组在T2～T5时升高（P〈0．05）。两组间比较：APaO2[P组（-1．3±7．7）、（-1．9±6．0），S组（-4．3±4．3）、（-3．1±5．3）]和AQS／Qt[P组（0．06±0．57）、（0．07±0．34），S组（0．71±0．86）、（0．72±0．95）]在T1～T2、T2～T3时间段比较差异均有统计学意义（P〈0．05），S组IL-8、IL-10、TNF-α在T2—T5时均高于P组（P〈0．05）。结论单肺通气期间实施小潮气量联合低PEEP时，丙泊酚比七氟醚对肺内分流和氧合影响更小，产生炎性因子少。Objective To compare the effects of sevoflurane and propofol anesthesia on intrapulmonary shunt, oxygenation and inflammatory cytokines in small tidal volume combined with low positive end-expiratory pressure （PEEP） during one-lung ventilation. Methods Seventy-six ASA Ⅰ-Ⅲ patients undergoing elective esophagus cancer resection via right thoracotomy. Using a random number sequence, patients were divided into two groups （n=38）： propofol group （group P） and sevoflurane group （group S）. Propofol infusion in the group P and sevoflurane inhalation in the group S maintained a bispectal index （BIS） at 40-50 during the operation. The other drugs were same in the two groups. Blood samples were taken simultaneously from radial artery and jugular venous for measurement of blood gases and calculation of intrapulmonary shunt （Qs/Qt）, and the blood concentrations of interleukin （IL）-8, IL-10, tumor necrosis factor（TNF）-α were measured before operation （To）, and at 30（TI）, 60（T2）, 90 min（T3） after one-lung ventilation, and at 30 （T4）, 60 min （Ts） after two-lung ventilation. In addition, the values of arterial partial pressure of oxygen （PaO2）, Qs/Qt between two time points（/~ PaO2, AQs/Qt） were also calculated. Results Compare with that at To, the Qs/Qt, TNF-α, IL-8 and IL-10 increased significantly, while the PaO2 decreased significantly at TI-T5 in the two groups （P〈0.05）. Compare with that at Tl, the PaO2 increased significantly and the Qs/Qt decreased significantly at T4, T5 in the two groups （P〈0.05）, the IL-8, IL-10 and TNF-a increased significantly at T3-T5 in the P group and decreased significantly at T2-T5 in the group S（P〈0.05）. The APaO2[group P （-1.3±7.7）, （-1.9±6.0）, group S（-4.3±4.3）, （-3.1±5.3）], the AQs/Qt [group P（0.06±0.57）, （0.07±0.34）, group s（0.71±0.86）, （0.72±0.95）] in the T1-T2, T2-T3, and the IL-8, IL-10, TNF-α at T2-T5 were significantly different between the P and S groups �

关 键 词：丙泊酚 七氟醚 单肺通气 肺内分流 炎性因子 

分 类 号：R614[医药卫生—麻醉学]