不同麻醉方法对体外循环后患者肺损伤的影响  

Fffects of anesthesia on luna iniurv after cardiopulmonary bypass in patients undergoing coronary artery bypass surgery:sevoflurane plus propofol versus propofol

作　　者：陈菲菲[1] 林丽娜[1] 李丽伶[1] 

机构地区：[1]温州医科大学附属第一医院麻醉科,325000

出　　处：《浙江医学》2015年第10期843-845,共3页Zhejiang Medical Journal

基　　金：温州市科技局科研基金项目(Y20100242)

摘　　要：目的探讨全程七氟烷吸入复合丙泊酚和全凭丙泊酚对体外循环后患者肺损伤的影响。方法将30例体外循环下行冠脉搭桥手术患者按随机数字表法分为七氟烷复合丙泊酚组（S组）和全凭丙泊酚组（P组），每组15例。S组患者从手术切皮开始至手术结束（包括体外循环），全程吸入1％～2％七氟烷复合丙泊酚1．0μg／ml静脉泵入；P组则全程TCI泵入丙泊酚2．0～40ug／ml。分别于体外循环前（T0）和体外循环停机后20min（T1）、1h（T2）、2h（T3）、6h（T4）和24h（T5）计算肺泡动脉氧分压差[P（A—aDO2）]、呼吸指数（RI）。测定动脉血中性粒细胞计数（PMN）及肺表面活性蛋白-A（SP—A）和TNF—α水平。结果与体外循环前比较，两组患者体外循环后P（A—aDO2）和RI、SP—A、TNF—α及PMN水平均有所升高，T3达高峰（P〈0．01）；与P组比较，S组T2～T5时点P（A—aDO2）和RI、SP—A、TNF—α及PMN水平较低（P〈0.05或0.01）。结论与单纯丙泊酚比较，全程七氟烷吸入复合丙泊酚能改善体外循环后患者全身炎症反应和肺损伤。Objective To investigate the effects of inhalational sevofiurane plus intravenous propofol and total intravenous propofol on lung injury after cardiopulmonary bypass （CPB）. Methods Thirty patients scheduled for coronary artery bypass surgery under CPB were randomly divided into two groups： inhalational sevofiurane plus intravenous propofol group （group S） and total intravenous propofol group （group P） with 15 cases in each group. Patients in group S received 1%-2% sevoflurane inhalation combined with intravenous infusion of 1.0 μ g/ml propofol, while patients in group P were given total 2.0- 4.0μg/ml intravenous propofol only. Continuous infusion of cisatracurium and intermittent sufentanyl were given to maintain the depth of anesthesia. Alveolar-arterial oxygen tension difference [P（A-aDO2） ] and respiratory index（RI） values, and the levels of pulmonary surfactant （SP）-A, tumor necrosis factor （TNF）- α and neutrophil counts were measured before CPB（To） and 20min（T1）, 1h（T2）, 2h（T3）, 6h（T4） and 24h（T5）after CPB. Results As compared to baselines before CPB, the levels of PA-aDO2, RI, SP-A, TNF-α and neutrophil counts were all significantly increased peaking at 2h after CPB in both groups （P〈0.01）; the levels of P （A-aDO2）, RI, SP-A, TNF- α and neutrophil counts were lower in group S than those in group P from 1h to 24h after CPB （P〈0.05）. Conclusion Compared to total intravenous popofol, combination of intravenous propofol and inhalational sevofiurane may alleviate systemic inflammatory response and lung injury in patients receiving CPB.

关 键 词：七氟烷 体外循环 肺损伤 肺表面活性蛋白-A 

分 类 号：R614[医药卫生—麻醉学]