丙泊酚复合氟比洛芬酯麻醉对Uni-VATS术中单肺通气患者的肺功能保护作用观察  

Protective Effect of Propofol Combined with Flurbiprofen on Lung Function in uni-VATS Patients Undergoing One-lung Ventilation

作　　者：王洪 杨尹 Wang Hong;Yang Yin(Department of Anesthesiology,Chongqing Three Gorges Central Hospital,Chongqing 404000,China)

机构地区：[1]重庆三峡中心医院麻醉科,重庆404000

出　　处：《中国药师》2020年第9期1788-1791,1825,共5页China Pharmacist

摘　　要：目的:观察丙泊酚联合氟比洛芬酯对行单孔胸腔镜(Uni-VATS)术中单肺通气患者的肺功能保护作用。方法:接受Uni-VATS肺叶切除术的非小细胞肺癌(NSCLC)患者128例随机分为对照组和观察组,每组64例。对照组给予丙泊酚麻醉,观察组在对照组基础上加用氟比洛芬酯。比较两组术后肺功能指标和并发症发生率,观察两组患者麻醉前后肺组织损伤评分、炎症因子[白细胞介素-10(IL-10)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]、血栓素B2(TXB2)、6-酮-前列腺素1α(6-K-PGF1α)、血红素加氧酶(HO-1)、乏氧诱导因子-1α(HIF-1α)等指标变化。结果:术后24 h,观察组患者FVC、FEV1、用力呼气容积、PEF及FEV1/FVC等肺功能指标均显著优于对照组(P<0.05)。单肺通气结束时,两组肺组织损伤评分均较前显著升高,HO-1及HIF-1α水平也较前显著提高(P<0.05);观察组的损伤评分低于对照组,HO-1及HIF-1α水平显著高于对照组(P<0.05)。单肺通气后60 min和90 min,两组患者的血清IL-10、IL-1β、TNF-α水平较前进行性升高(P<0.05),观察组炎症因子水平明显低于对照组(P<0.05)。单肺通气15 min、30 min及结束时,两组患者的6-K-PGF1α、TXB2水平均较前降低,观察组低于对照组(P<0.05);两组TXB2/6-K-PGF1α的比值则较前升高,且观察组明显高于对照组(P<0.05)。观察组总并发症发生率低于对照组(P<0.05)。结论:丙泊酚联合氟比洛芬酯对行单孔胸腔镜术的单肺通气机械损伤患者具有良好的肺保护效果,能有效降低患者炎症反应及缺血缺氧反应,改善患者氧合,并发症少。Objective:To observe the protective effect of propofol combined with flurbiprofen on lung function in patients undergoing single-pore thoracoscopic(Uni-VATS)ventilation.Methods:Totally 128 patients with non-small cell lung cancer(NSCLC)undergoing Uni-VATS lobotomy were randomly divided into the control group and the observation group with 64 patients in each group.The control group was anesthetized with propofol,and the observation group was treated with flurbiprofen ester on the basis of the control group.The pulmonary function index and complication rate after operation were compared between the two groups,and the changes of lung tissue injury score,inflammatory factors[interleukin-10(IL-10),interleukin-1β(IL-1β),tumor necrosis factor(TNF-α)],thrombin B2(TXB2),6-K-PGF1α,HO-1,HIF-1αand the other indices before and after anesthesia were observed.Results:24 hours after operation,the lung function indexes such as FVC,FEV1,forced expiratory volume,PEF and FEV1/FVC in the observation group were significantly better than those in the control group(P<0.05).At the end of one-lung ventilation,the lung tissue damage score of the two groups were significantly higher than that before,and the levels of HO-1 and HIF-1αwere also significantly higher than that before(P<0.05);The injury score of the observation group was lower than that of the control group,but the levels of HO-1 and HIF-1αwere significantly higher than those of the control group(P<0.05).60 min and 90 min after one-lung ventilation,the levels of serum IL-10,IL-1B,and TNF-A of the two groups of patients increased progressively than those before(P<0.05),while the levels of inflammatory factors in the observation group were significantly lower than those in the control group(P<0.05);15 min,30 min and at the end of one-lung ventilation,the levels of 6-K-PGF1αand TXB2 in the two groups were lower than those before,and the levels of 6-K-PGF1αand TXB2 in the observation group was lower than those in the control group(P<0.05);The ratio of TXB2/6-K-PGF1αof the

关 键 词：丙泊酚 氟比洛芬酯 单孔胸腔镜 单肺通气 肺保护效果 

分 类 号：R971.2[医药卫生—药品]