七氟烷对体外循环肺损伤的保护作用

目的探讨七氟烷对心脏瓣膜病患者体外循环（CPB）后肺损伤的保护作用。方法选择体外循环心脏瓣膜病变患者40例，随机分为对照组（C组，10例）和七氟烷吸入组（S组，30例），对照组采用静脉麻醉，不使用任何吸入麻醉药，七氟烷吸人组分为S1、S2、S3三个亚组，每组10例，体外循环后分别吸入0．5、1．0、1．5MAC的七氟烷维持麻醉。四组病人术前用药、麻醉诱导、体外循环前和体外循环过程中麻醉维持、体外循环方法均相同，分别于麻醉诱导前（T0）、体外循环前（T1）、停机（T2）、手术结束（T3）、术后2h（T4）、术后4h（T5）、术后8h（T6）、术后12h（T7）、术后24h（T8）测量患者动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、潮气量（VT）、气道压、吸入氧浓度（FiO2），计算患者肺泡动脉氧分压差（A-aDO2）、氧合指数（OI）、肺动态顺应性（Cdyn）、肺静态顺应性（CStat），观察肺氧合与肺顺应性变化。结果与C组比较，S1、S2、S3组肺氧合功能好转（P〈0．05），顺应性上升（P〈0．05）。结论七氟烷麻醉能减轻体外循环导致的肺损伤，并和七氟烷的吸人量成正相关。

Protective effects of sevoflurane on CPB related pulmonary injury

Objective To investigate the protective effects of sevoflurane on pulmonary injury in patients suffered valvulopathy after cardiopulmonary bypass（CPB）. Methods Forty patients were randomly divided into four groups： control group（group C）, evoflurane group（group S1, group S2, group S3）. The patients of group C were only treated with intravenous anesthetics; 0.5MAC, 1.0MAC, 1.5MAC sevoflurane were inhalated in group S1,S2,S3 after CPB. Patients in all groups were the same in premedication, anesthetic induction, maintenance of anesthesia before and during CPB, method of cardiopulmonary bypass. PaO2, PaCO2, VT, FiO2, A-aDO2, OI ,Cdyn, Cstat were measured before induction of anesthesia （T0）, before CPB（T1）, at the discontinuation of CPB（T2）, at the end of operation（T3）, 2 h（T4）, 4 h（T5）, 8 h（T6）, 12 h（T7）, 24 h（T8） after operation. Results Compared with group C, the pulmonary oxygenation function of patients in group S 1,S2,S3 was better respectively after operation（P〈0.05）; the compliance of pulmonary was raised respectively（P〈0.05）. Conclusion Sevoflurane inhalated anesthesia can reduce lung injury in patients after cardiopulmonary bypass, and its lung protection is related to the amount of sevoflurane positively.