七氟醚对胸科手术单肺通气患者血清炎性介质、.doc

七氟醚对胸科手术单肺通气患者血清炎性介质、 呼吸动力学及氧合的影响 单位：安徽省立医院南区 邮编：230036 作者：马骏 李娟 联系电话摘要 目的：单肺通气时常出现低氧血症，低氧血症又可以引起术中及术后并发症，因此如何避免术中低氧血症的发生一直是胸科麻醉的研究热点。七氟醚对多种器官有保护作用，其机制与抑制炎症反应及免疫调节等因素有关。本试验评价胸科单肺通气引起的炎症反应，探索七氟醚对单肺通气引起肺损伤的作用及对炎症反应的影响。方法：60例食道癌患者随机分为对照组（异丙酚组）34例和试验组（七氟醚组）26例。患者术前30min静注长托宁0.01-0.02mg/kg，常规监护（心电图、血压、脉搏氧饱和度、呼末二氧化碳浓度）。行有创动脉压监测及围麻醉期BIS监护。麻醉采用硬膜外阻滞复合支气管麻醉的方法。患者侧卧位下行T6-7或T7-8硬膜外穿刺置管，并持续泵入0.2% 罗哌卡因5ml/h；全麻诱导为丙泊酚1-2mg/kg、舒芬太尼0.4-0.6ug/kg、罗库溴铵0.6-1mg/kg，诱导后插入双腔气管插管，并使用纤维支气管镜调整双腔管位置，术中实施单肺通气，对照组使用异丙酚维持麻醉，试验组麻醉维持使用七氟醚，调整麻醉药剂量维持BIS值40-60范围。术中靶控输注瑞芬太尼（2-3ng/ml），间断静脉注射维库溴铵2-4mg/次维持肌松。记录患者气道峰压及潮气量等参数，检测不同时间点血清IL-1β、IL-10、TNF-α、MMP-9、MPO的浓度，并进行动脉血气分析，观察患者术后恢复情况。结果：因术中出现低氧血症（SPO290%）排除患者11例，其中七氟醚组3例，异丙酚组8例；两组患者围麻醉期血流动力学和肺顺应性无差异；与异丙酚组相比，七氟醚提高T2、T5时患者的PaO2，降低在T2时IL-1β的浓度，在T3、T5时IL-1β、IL-10、TNF-α、MMP-9的浓度，在T6时IL-1β、MMP-9、TNF-α的浓度；两组MPO未见差异；七氟醚组患者术后恢复情况优于异丙酚组。结论：七氟醚改善肺氧合水平，抑制炎症反应，促进患者术后恢复，在胸科单肺通气中应用具有一定优势。 Abstract The effect of Sevoflurane on Serum Inflammatory Factors, Pneodynamics and Oxygenation in the patients undergoing OLV during the thoracic surgery Jun MA, Juan LI, Hong DONG Dept. of anesthesiology, AnHui Provincial Hospital south district, Hefei230001,China. Objective To investigate one-lung-injury(OLV) induced systematic inflammation response(SIRS), and search for effects of sevoflurane on acute lung injury and SIRS. Methods Sixty patients were randomly divided into Propofol group (34 patients) and Sevoflurane group (26 patients). Propofol, Sufentanyl and Rocuronium were administrated intravenously for anesthesia inducation. Double lumen tubes were inserted for OLV. Propofol and sevoflurane were used for anesthesia maintain respectively. The serum level of IL-1β,IL-10,TNF-α,MMP-9,MPO were observed at difference times by ELISA. blood-gas analyzes were obtained and the information of Post-anesthesia was investigated. Results PaO2 in sevoflurane group has increased at T2,T5 time points, and the level of IL-1β、IL-10、TNF-α、MMP-9 in sevoflurane group has decreased at