雾化吸入前列腺素E1预防低吸入氧浓度单肺通气诱发低氧血症的效果  

Efficacy of inhalation of aerosolized prostaglandin E1 in preventing hypoxemia induced by one-lung ventilation with low fraction of inhaled oxygen

作　　者：李彭依 王丽君[1] 宋田皓 李甜甜 高蓉[1] 辜晓岚[1] 许仄平[1] 顾连兵[1] Li Pengyi;Wang Lijun;Song Tianhao;Li Tiantian;Gao Rong;Gu Xiaolan;Xu Zeping;Gu Lianbing(Department of Anesthesiology,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Xuzhou Medical University,Jiangsu Province Key Laboratory of Anesthesiology,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology,Xuzhou 221002,China)

机构地区：[1]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科,210009 [2]徐州医科大学,江苏省麻醉学重点实验室,江苏省麻醉与镇痛应用技术重点实验室,221002

出　　处：《中华麻醉学杂志》2020年第12期1427-1430,共4页Chinese Journal of Anesthesiology

基　　金：江苏省卫生健康委员会科研基金(BJ16028);江苏省肿瘤医院优才项目(YC201805)。

摘　　要：目的评价雾化吸入前列腺素E1(PGE1)预防低吸入氧浓度单肺通气(OLV)诱发低氧血症的效果。方法择期全麻下行左侧开胸食管癌根治术患者60例,性别不限,年龄50~79岁,BMI<30 kg/m2,ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=30):PGE1组(P组)和对照组(C组)。OLV开始前,P组经右侧肺雾化吸入PGE10.3μg/kg(生理盐水稀释至10 ml),C组经右侧肺雾化吸入等量生理盐水。于麻醉前(T0)、诱导后右侧卧位时(T1)、OLV 10 min(T2)、OLV 15 min(T3)、OLV 30 min(T4)、OLV 60 min(T5)及OLV 120 min(T6)时采集桡动脉和颈内静脉血样行血气分析,记录PaO2、PaCO2;记录局部脑氧饱和度(rSO2)、Ppeak,计算肺内分流率(Qs/Qt)、rSO2较基础值下降最大百分比。记录OLV期间低氧血症发生情况,术后1周随访肺及脑部并发症发生情况。结果与C组比较,P组低氧血症发生率(3%)降低,T2~4时PaO2升高,Qs/Qt降低(P<0.05),PaCO2、Ppeak、rSO2及rSO2较基础值下降最大百分比、肺及脑部并发症发生率差异无统计学意义(P>0.05)。结论雾化吸入PGE1可有效预防低吸入氧浓度OLV诱发的低氧血症。Objective To evaluate the efficacy of inhalation of aerosolized prostaglandin E1(PGE1)in preventing hypoxemia induced by one-lung ventilation(OLV)with low fraction of inhaled oxygen.Methods Sixty patients of both sexes,aged 50-79 yr,with body mass index<30 kg/m2,of American Society of Anesthesiologists physical statusⅡorⅢ,undergoing elective radical resection of left thoracotomy for esophageal cancer under general anesthesia,were divided into 2 groups(n=30 each)using a random number table method:PGE1 group(P group)and control group(C group).Before the onset of OLV,group P inhaled aerosolized PGE10.3μg/kg(diluted to 10 ml in normal saline)through the right lung,and group C inhaled the equal volume of aerosolized normal saline through the right lung.Before anesthesia(T0),in the right lateral position after induction(T1),and at 10,15,30,60 and 120 min of OLV(T2-6),blood samples were collected from the radial artery and internal jugular vein for blood gas analysis,and PaO2,PaCO2,regional cerebral oxygen saturation(rSO2)and Ppeak were recorded,and the intrapulmonary shunt rate(Qs/Qt)and proportion of the maximum decrease in rSO2 were calculated.The development of hypoxemia during OLV and lung and brain complications at 1 week after operation were recorded.Results Compared with group C,the incidence of hypoxemia was significantly decreased(P<0.05),PaO2 was increased and Qs/Qt was decreased at T2-4(P<0.05),and no significant changes were found in PaCO2,Ppeak,rSO2,proportion of the maximum decrease in rSO2 and incidence of lung and brain complications in group P(P>0.05).Conclusion Inhalation of aerosolized PGE1 can effectively prevent hypoxemia induced by OLV with low fraction of inhaled oxygen.

关 键 词：单肺通气 低氧 前列地尔 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]