术中非通气侧肺动、静脉血浆一氧化氮和内皮素的变化

目的 观察单肺不通气时对肺动、静脉中一氧化氮（NO）和内皮素（ET）的变化。方法 选择20例食管癌病例,插双腔管全麻,测定双肺通气（TLV）30min、单肺通气（OLV）后30、60min开胸侧肺动、静脉血浆NO和ET值,同时监测桡、肺动脉血气以计算以上不同时点肺内分流值。结果 OLV后,不同时点肺内分流值均比TLV时显著增加。非通气侧肺动、静脉血浆NO值在双、单肺通气期间变化不显著;而OLV后肺静脉血浆ET上升（P＜0．01）。结论 OLV肺泡缺氧时,肺静脉血中ET上升（P＜0．01）。结论 OLV肺泡缺氧时,肺静脉血中ET上升,而NO变化不明显,反映缺氧时引起肺内皮细胞分泌ET增加或肺组织对其清除作用减弱而参与缺氧下致肺血管收缩。

The changes of plasma endothelin and nitric oxide in the pulmonary artery and vein during one-lung ventilation

Objective To observe the changes of plasma endothelin (ET) and nitric oxide (NO) in the pulmonary artery and vein during one-lung ventilation (OLV) with intrapulmonary shunt. Methods Twenty patients underwent the radical resection of esophageal carcinoma with OLV under general anesthesia. The arterial and mixed venous blood gas analysis and the plasma concentrations of ET and NO in the pulmonary artery and vein were measured at 30 min after beginning two-lung ventilation (TLV), 30 min and 60 min after beginning OLV. Results The venous admixture percentages were higher at 30 and 60 min after beginning OLV than at 30 min after beginning TLV. There were no significant differences with respect to the plasma levels of NO in the pulmonary artery and vein during TLV and OLV. The concentration of ET in the pulmonary vein increased significantly after OLV (P<0.01). Conclusion The atelectasis and hypoxic stimulus during OLV can make pulmonary endothelium release ET or inhibit pulmonary elimination of ET. NO - 2/NO - 3 concentrations representative of NO are not changeable in the pulmonary artery and vein during OLV.