术中单肺通气期间吸入一氧化氮对患者氧合功能和全身炎性反应的影响  

Effect of inhalating nitric oxide on oxygenation and systemic inflammatory response during one-lung ventilation in thoracic surgical patients

作　　者：李卫霞[1] 李成辉 刘鲲鹏 李昭[1] 赵晶[1] LI Wei-xia;LI Cheng-hui;LIU Kun-peng(Department of Anesthesiology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院麻醉科,北京100029 [2]泰康宁波国际医院,江苏南京210046 [3]北京大学国际医院麻醉科,北京102206

出　　处：《中日友好医院学报》2020年第3期131-134,139,共5页Journal of China-Japan Friendship Hospital

摘　　要：目的:研究开胸手术患者侧卧位单肺通气(OLV)期间持续吸入一氧化氮(iNO)对氧合功能和全身炎性反应的影响。方法:40例拟行全身麻醉下侧卧位OLV的择期开胸手术的患者随机分组:NO组20例,OLV期间吸入100%氧气同时持续吸入20ppm NO;对照组20例,仅吸入100%氧气。常规静脉全身麻醉,采用双腔气管插管实现OLV。在入手术室尚未吸氧时(T1)、摆放侧卧位后双肺通气(TLV)20min后(T2)、OLV 15min后(T3)、OLV 30min后(T4)、OLV结束时(T5)抽取桡动脉血1ml。于T2~T5取中心静脉血1ml进行血气分析,计算肺内分流率(Qs/Qt)。在T2、T4、T5取静脉血测定血清中白介素-6(IL-6)、IL-8和IL-10的浓度。结果:2组患者OLV期间T3~T5与T2相比,Qs/Qt均显著增高,PaO2均显著降低。T4时NO组Qs/Qt显著低于对照组、PaO2显著高于对照组(均P<0.05)。IL-10水平在T4、T5 NO组显著低于对照组(P<0.01,P<0.05)。结论:OLV期间iNO可以减少OLV初期的肺内分流并改善氧合,对OLV期间肺损伤相关全身炎性反应可能存在一定的抑制作用。Objective:To assess the effect of persistent inhalation of nitric oxide(iNO)20ppm on improving oxygenation and attenuating inflammatory response during one-lung ventilation(OLV)in patients in lateral decubitus position undergoing thoracic surgery.Methods:Forty patients who were scheduled for elective thoracic surgery were assigned to receive persistant inhalation of 20 ppm nitric oxide with 100%oxygen(NO group,n=20)or only 100%oxygen(control group,n=20).Lung separation was achieved with a double-lumen tube(DLT).Blood samples for blood gas analysis were taken from radial artery and the internal jungular vein catheter at the following time points:T1,before induction of anesthesia while the patients were in supine and breathing room air;T2,20min after two-lung ventilation in lateral decubitus position(LDP);T3,15min after initiation of OLV in LDP;T4,30min after initiation of OLV in LDP;T5,the end of OLV in LDP.Serum interleukin(IL)-6,8,10 concentrations at T2,T4,T5 were measured using ELIS A.Results:PaO2 decreased significantly during OLV as compared with that before OLV in both NO group and control group.Compared with the control group,the intrapulmonary shunt(Qs/Qt)of NO group was significantly lower and the PaO2 of NO group was significantly higher at T4(both P<0.05).The level of IL-10 in NO group was significantly lower than those in the control group at T4 and T5 time points(P<0.01,P<0.05).There were no significant differences in the levels of IL-6 and IL-8 between the two groups.Conclusion:During OLV,iNO could reduce the intrapulmonary shunt and improved oxygenation,and it may inhibit the systemic inflammatory response related to lung injury during OLV.

关 键 词：单肺通气 一氧化氮 氧合 肺内分流率 炎性反应 

分 类 号：R614.27[医药卫生—麻醉学]