七氟烷对单肺通气患者围麻醉期肺氧合功能的影响

目的：探讨七氟烷对单肺通气患者围麻醉期肺氧合功能的影响。方法择期胸科食道癌手术患者60例，性别不限，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，年龄48～75岁，体质指数（BMI）20～30 kg·m －2，采用随机数字表法，将其分为两组，各30例：七氟烷组（S 组）和丙泊酚组（P 组）。S 组麻醉维持时吸入七氟烷（1．0％～2．5％），P 组采用静脉注射丙泊酚（1．5～3 mg·L －1）维持，两组分别静脉注射瑞芬太尼和维库溴铵。于麻醉前（T1）、双肺通气15 min（T2）、单肺通气15、30及60 min （T3～5）及恢复双肺通气15 min（T6）时分别记录心率（HR）、血压（BP）、脉搏氧饱和度（SpO2）及吸气峰压（Ppeak ），计算肺动态顺应性（Cdyn ）；在 T2、T5、T6时采集血标本，通过血气分析测量氧合指数（OI）；从切除肺叶中取健康肺组织标本，采用免疫组化法测定 NF-κB 水平；术后随访并发症发生情况和住院时间。结果两组各时点 HR、BP、SpO2、Cdyn 及 Ppeak 比较无统计学意义（P ＞0．05）；与 P 组比较，S 组在 T5时 OI、PaO2升高，肺组织中 NF-κB 表达水平弱，术后呼吸困难发生率降低（P ＜0．05），两组其他并发症及平均住院时间差异无统计学意义（P ＞0．05）。结论七氟烷在改善单肺通气时和术后肺氧合功能方面优于丙泊酚，其机制可能与抑制 NF-κB 表达有关。

Effect of sevoflurane on lungs oxygenation function in patients undergoing one-lung ventilation

Objective To investigate the effect of sevoflurane on lung oxygenation functions in patients undergoing one-lung ventilation (OLV).Methods Sixty patients undergoing esophagus surgery with OLV were randomly assigned to Group S and Group P.Propofol, sufentanyl and rocuronium were administered for induction in both groups.Left-or right-sided double-lumen endobronchial tubes were inserted for OLV.Maintenance anesthesia was performed with sevofluarane in Group S,and propofol in Group P.Remifentanil and ven-curonium were used in both groups.In addition,ventilation machine was set at the same way in both groups.Heart rate(HR),oxygen saturation(SPO2 ),mean arterial pressure(MAP),tidal volumes(VT ),airway peak pressure(Ppeak )were recorded before anesthesia (T1 );15 min after double-lung-ventilation(T2 );15 min(T3 ),30 min(T4 ),60 min(T5 )after OLV and 15 min(T6 )after reventilation of the deflated lung.Lung dynamic compliance(Cdyn )and oxygen index(OI)were calculated.Arterial blood gas analysis was performed at T2 ,T5 ,T6 .The clinical outcome was investigated.Results There were no differences in HR,SPO2 ,MAP,Ppeak ,Cdyn between groups. Compared with group P,PaO2 and OI in group S had increased at T5 ;the postoperative dyspnea in group S was better than that in group P.Conclusion Sevoflurane improves lung oxygenation during OLV and postoperative dyspnea,possibly due to refraining in the level of NF-κB.