七氟醚预处理对肺叶切除术患者单肺通气诱导氧化应激损伤的影响

目的 观察肺叶切除术患者七氟醚预处理对术侧肺组织血红素氧合酶1(HO 1)表达水平的影响及其肺保护作用。方法 择期拟行单纯肺叶切除术患者30名，ASA分级Ⅰ～Ⅱ级 ，年龄40～60岁，体质量50～75kg，按照随机数字表法，分为丙泊酚全凭静脉麻醉组(P组)和七氟醚预处理组(S组)。S组单肺通气前吸入1%~2%七氟醚30min，模拟七氟醚预处理，P组在此阶段采用丙泊酚静脉麻醉作为对照。分别于诱导开始前即刻(T0)、单肺通气前即刻(T1)，单肺通气结束前即刻(T2)，双肺通气30min(T3)抽取肘静脉血4mL，测定血清丙二醛(MDA)的浓度。从切除肺叶取小块正常肺组织，测定肺组织HO 1的含量。术后2h抽取桡动脉血1mL，测定肺氧合指数。结果 术侧肺叶组织HO 1浓度S组高于P组(P<0.05)，T3时刻血清MDA浓度S组低于P组(P<0.05)。术后2h时肺氧合指数S组高于P组(P<0．05)。结论 七氟醚预处理可通过上调肺组织HO 1的表达水平，减轻单肺通气诱导的氧化应激损伤，产生肺保护作用。

Effects of sevoflurane preconditioning on the oxidative stress injury induced by one-lung ventilation in patients with pulmonary lobectomy

Objective To observe the effects of sevoflurane preconditioning on the expression of heme oxygenase-1(HO-1) in the operated lung tissue,and on the lung protection of patients who underwent pulmonary lobectomy.Methods 30 patients,ASAⅠ or Ⅱ,aged 40 to 60 years,weighting 50 to 75 kg,scheduled for pulmonary lobectomy,were randomly divided into two groups with 15 cases in each group,including propofol all by intravenous anesthesia group(group P) and sevoflurane preconditioning group(group S).In group S,before one-lung ventilation,the patients inhaled 1% to 2% sevoflurane for 30 mins,as a simulation of sevoflurane preconditioning.While in group P,patients were supplied propofol all by intravenous anesthesia in the same period.4 mL elbow venous blood samples were collected at the beginning of the anesthesia induction(T0),immediately before one-lung ventilation(T1),immediately at the end of one-lung ventilation(T2),30 mins after one-lung ventilation(T3),respectively,in order to determine the level of serum malondialdehyde(MDA).The content of heme oxygenase-1 in the normal lung tissue of removal pulmonary lobe was detected.1 mL radial artery blood samples were collected for measuring the oxygenation index(PaO2/FiO2) at 2 h after surgery.Results The content of HO-1 of removal lung tissue was significantly higher in group S than in Group P(P<0.05).At the time point of T3,the level of serum MDA was significantly lower in group S than in group P(P<0.05).At 2 h after surgery,the oxygenation index(PaO2/FiO2) was significantly higher in group S than in group P(P<0.05).Conclusion Sevoflurane preconditioning can play a role in lung protection by up-regulating the expression of HO-1 in lung tissue,and reducing the oxidative stress injury induced by one-lung ventilation.