高渗氯化钠对单肺通气肺的病理学影响

目的探讨高渗氯化钠对单肺通气患者的病理学影响。方法选择拟单肺通气剖胸手术ASAⅠ-Ⅱ级的患者60例，随机分为高渗氯化钠治疗组（H组）和对照组（C组），每组30例。在单肺通气30min时经中心静脉导管输注7．5％氯化钠溶液（H组）或生理盐水（C组）2mL／kg。观察开始进行单肺通气（T1）、单肺通气30min（T2）、输注完成后30min（L）、输注后60min（L）、单肺通气结束（L）5个时点的动态肺顺应性（Cdyn）、气道峰压（Ppeak）、气道平均压（Pmean）、动脉血氧分压（P（O2））、血清Na^＋浓度，并于T1、T5时各取肺组织1块，切片染色高倍镜下观察。结果2组患者T1与T2时间段比较，Cdyn、P（O2）明显降低，Ppeak、Pmean明显升高。H组T3、T4、T5与T2比较，Cdyn、P（O2）逐渐升高，Ppeak、Pmean逐渐下降，且H组T3、T4、T5的Cdyn、P（O2）明显高于C组，Ppeak明显低于C组，H组T4、T5的Pmean明显低于C组。而C组患者T3、T4、T5的Cdyn、Ppeak、Pmean、P（O2）与T2比较无显著性差异。切片观察到H组出现肺组织病理学改变的明显少于C组。结论7．5％氯化钠溶液对单肺通气患者的各呼吸力学参数有改善作用，能明显减少肺组织损伤，对肺通气功能具有保护作用。

Pathology effect of hypertonic sodium chloride on one-lung ventilation

Objective It is to explore the effect of hypertonic sodium chloride on pathology in. Methods 60 patients with ASA Ⅰ - Ⅱ level undergoing one-lung ventilation thoracotomy were randomly divided into hypertonic saline treatment group （group H） and control group （group C） , 30 eases in each one. In the first one-lung ventilation via central venous catheter at 30 min infusion of 7.5% sodium chloride solution （ group H） or saline （group C） 2 mL/kg. Dynamic lung compliance （Cdyn） , peak airway pressure （Ppeak） , mean airway pressure （Pmean） , arterial oxygen pressure （p（ O2 ）） , serum Na ＋ concentration were observed at five points in time which were begin one-lung ventilation （ T1 ）, one-lung ventilation section 30 min （ T2 ） , after the first infusion 30 min （ T3 ） , after infusion 60 min （ T4 ） , the end of one-lung ventilation （ T5 ） , and in T1, T5 lung tissue from each piece of stained sections were observed under high-powered microscope. Results Cdyn, p（ O2 ） decreased and Ppeak, Pmean significantly increased at T1 and T2 in both groups（P 〈0.05）. Cdyn, p（ O2 ） increased gradually and Ppeak, Pmean significantly decreased at T3, T4 and T5 compared with that at T2 in group H, and Cdyn, p（ O2 ） were obviously higher and Ppeak was significantly lower at T3 , T4 and T5 in group H compared with that in group C. Pmean was lower at T4 and T5 in group H than that in group C. Compared with that at T2, no significant difference in Cdyn, Ppeak, Pmean, p（O2） at T3, T4 and Ts in group C was found. Pathology changes of lung tissue in group H were less than that in group C. Conclusion 7.5% sodium chloride solution has improving effect on various respiratory mechanics parameters in onelung ventilation patients, and can significantly reduce lung injury and has protective function on pulmonary function.