单肺通气时应用乌司他丁与帕瑞昔布钠对肺内分流率的影响  

Effect of ulinastatin and parecoxib sodium on intrapulmonary shunt fraction during one lung ventilation

作　　者：李海英[1] 李世多 郭建[1] 王燕[1] 

机构地区：[1]陕西省延安市人民医院麻醉科,陕西延安716000

出　　处：《实用药物与临床》2017年第1期30-34,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨单肺通气时应用乌司他丁与帕瑞昔布钠对肺内分流率变化的影响。方法选取2014年4月至2015年4月行单肺通气根治的100例食道癌手术患者作为观察对象。按照患者意愿将其分为A组、B组每组50例。两组患者均给予相同的麻醉诱导方式、麻醉用药、麻醉深度维持。麻醉前0.5 h,A组患者给予帕瑞昔布钠40 mg,B组患者给予乌司他丁50 U。对比两组患者麻醉诱导后(S_1期)、单肺通气0.5 h(S_2期)、单肺通气1 h(S_3期)、恢复双肺通气0.5 h(S_4期)时气道平均压、心率、平均动脉压、血氧饱和度、动脉二氧化碳分压、肺内分流率、白介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α、C-反应蛋白(CRP)表达量。结果 A组患者S_4期时平均动脉压(77.9±11.5)高于B组(73.6±9.1)差异有统计学意义(P<0.05)。A组患者在S_2期、S_3期、S_4期时,动脉二氧化碳分压(41.4±3.8、41.8±3.4、41.7±2.8)均高于B组(42.7±2.1、42.7±2.1、44.8±3.7),差异有统计学意义(P<0.05)。A组患者在S_2期、S_3期时肺内分流率均明显低于B组,两组患者在S_2期、S_3期时肺内分流率均高于S_4期。结论帕瑞昔布钠与乌司他丁在单肺通气时对肺组织均具有保护作用,但单肺通气时应用帕瑞昔布钠,可更大程度上降低肺内分流率,避免手术过程中对肺组织的损伤。Objective To explore the effect of ulinastatin and parecoxib sodium on intrapulmonary shunt during one lung ventilation.Methods One hundred patients receiving one lung ventilation treatment for esophageal cancer from April 2014 to April 2015 were involved as the observation objects.According to the patient preference,patients were divided into group A（n =50） and group B（n =50）.The same induction of anesthesia and anesthesia drugs were given to them to maintain the same depth of anesthesia.Half an hour before anesthesia,40 mg parecoxib sodium was given to group A,and 50 U UTI was given to group B.The mean airway pressure,heart rate,mean arterial pressure,oxygen saturation,arterial carbon dioxide partial pressure,pulmonary shunt fraction,interleukin（IL）-6,IL-8 Junior necrosis factor α and C-protein expression were compared at the following time points：after induction of anesthesia（S_1 period）,0.5 h after one-Lung ventilation（S_2 period）,1 h after one lung ventilation（S_3 period） and 0.5 h after restoring lung ventilation（S_4 period）.Results The mean arterial pressure of group A（77.9 ± 11.5） was higher than that of group B（73.6 ± 9.1） at the period of S4,the difference was statistically significant（P〈0.05）.The arterial carbon dioxide tension of group A（41.4 ±3.8,41.8 ±3.4,41.7 ±2.8） was higher than that of group B（42.7 ± 2.1,42.7 ±2.1,44.8 ±3.7） at the period of S_2,S_3 and S_4,the difference were statistically significant（P〈0.05）.The pulmonary shunt fraction of group A was lower than that of group B on the period of S_2 and S_3.The pulmonary shunt fractions of the two groups on the period of S_2 and S_3 were higher than those on the period of S_4.Conclusion Parecoxib sodium and ulinastatin have protective effect on one lung ventilation,but parecoxib sodium reduces intrapulmonary shunt fraction more significantly which can avoid the damage to the lung tissue to some extent.

关 键 词：帕瑞昔布钠 乌司他丁 单肺通气 肺内分流率 

分 类 号：R614[医药卫生—麻醉学]