| 摘要: |
| 比较丙泊酚或七氟烷维持麻醉对单肺通气患者围术期炎性细胞因子、氧化—抗氧化平衡的影响，探讨不同的麻醉剂维持对肺的保护作用。方法：择期行胸腔镜肺叶切除术患者40例（样本例数），年龄45~70岁，性别不限，ASAⅠ~Ⅱ级。麻醉诱导均采用咪达唑仑0.05 mg/kg,舒芬太尼0.3~0.5 μg/kg,依托咪酯乳剂0.15~0.3 mg/kg,顺苯磺酸阿曲库铵0.2 mg/kg 。麻醉维持随机分为两组，丙泊酚组（n=20）静脉泵入4~10mg·kg-1·h-1丙泊酚和七氟烷组（n=20）吸入1%~3%七氟烷，于麻醉诱导前（T0）、单肺通气开始前（T1）、单肺通气后30 min（T2）、术毕（T3）采集桡动脉血测量血浆IL-6、IL-10、MDA、SOD浓度。结果：与组内比较，丙泊酚组T2时刻IL-6、IL-10、MDA浓度分别为（64.8±26.4）ng/L、（176.6±41.8）ng/L、（6.7±1.5）mmol/L，T3时刻上述指标水平分别为（79.2±29.1）ng/L、（197.8±51.2）ng/L、（8.2±1.9）mmol/L；与T0时比较均明显降低（P<0.05）；T2、T3时刻SOD浓度分别为（66.6±7.0）U/L、（69.6±6.2）U/L，均明显高于T0时水平（P<0.05）；七氟烷组T2时刻IL-6、IL-10、MDA浓度分别为（82.3±26.1）ng/L、（152.9±28.3）ng/L、（7.9±1.3）mmol/L，T3时刻上述指标水平分别为（96.3±18.4）ng/L、（168.2±38.3）ng/L、（9.7±1.6）mmol/L，与T0时比较均明显升高（P<0.05）；T2、T3时刻SOD浓度分别为（65.3±9.0）U/L、（58.8±8.5）U/L，与T0时比较明显降低（P<0.05）。丙泊酚组各时间点IL-6/ IL-10比值均小于T0水平，而七氟烷组T2、T3时IL-6/ IL-10比值均大于T0水平（P<0.05）。组间比较，与七氟烷组比较，T1时刻丙泊酚组各指标间差异均无统计学意义(P>0.05）；丙泊酚组T2及T3时刻IL-10和SOD浓度均明显升高(P<0.05），IL-6、MDA浓度均明显降低，均有统计学意义(P<0.05）。七氟烷组T1、T2、T3各时间点IL-6/ IL-10比值均大于丙泊酚组相应时间点水平(P<0.05）。结论：丙泊酚维持麻醉更有利于单肺通气促炎细胞因子与抗炎细胞因子平衡、氧化和抗氧化平衡，对单肺通气时所致的肺损伤具有一定保护作用。 |
| 关键词: 丙泊酚 七氟烷 单肺通气 肺保护 |
| DOI：10.3969/j.issn.1007-6948.2019.01.008 |
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| 基金项目: |
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| Propofol Maintenance Anesthesia for Lung Protection in Patients Undergoing One-lung Ventilation. |
| ZHAO Zhen-ru,MIAO Li-na,WANG Jing-jing,LIU Jun |
| Department of Anesthesiology, Chengde Central Hospital of Hebei Province, Chengde(067000), China;Ningxia Medical University (Yinchuan 750004);Department of Anesthesiology, General Hospital of Ningxia Medical University (Yinchuan 750004) |
| Abstract: |
| Objective To compare the effects of propofol and sevoflurane anesthesia maintain on inflammatory cytokines and Oxidation - antioxidant balance during perioperative period in patients undergoing one-lung ventilation and to discuss the mechanism of different anesthesia maintain induced lung protection. Methods Forty ASAⅠorⅡpatients(24 male, 16 female)aged 45-70 yr underwent elective pulmonary resection were observed. Anesthesia induction is practiced in two groups by intravenous injection: Midazolam 0.05mg/kg, Sufentanil 0.3~0.5ug/kg, Etomidate 0.15~0.3 mg/kg, Cisatracurium Besilate0.2mg/kg, anesthesia maintain were randomly divided into two groups(n=20 each); continuous intravenous Propofol infusion 4~10mg/(kg·h) with miero-Pump(GroupⅠ)and inhaled l%~3% sevoflurane(GroupⅡ). Aterial blood concentrations of IL-6、IL-10、MDA and SOD were measured at before induction of anesthesia( T0) ,before the start of one-lung ventilation( T1),30 min after one-lung ventilation( T2), and at the end of the operation( T3). Results Compared within group, the concentrations of IL-6, IL-10 and MDA in propofol group at T2 were (64.8+26.4) ng/L, (176.6+41.8) ng/L, (6.7+1.5) mmol/L, and the above-mentioned indexes at T3 were (79.2+29.1) ng/L, (197.8+51.2) ng/L, (8.2+1.9) mmol/L respectively, which were significantly lower than those at T0 (P<0.05). The concentration of SOD at T2 and T3 were (66.6+7.0) U/L and (69.6+6.2) U/L, which were significantly higher than those at T0 (P<0.05); the concentration of IL-6, IL-10 and MDA at T2 in sevoflurane group were (82.3+26.1) ng/L, (152.9+28.3) ng/L, (7.9+1.3) mmol/L, and the above indexes at T3 were (96.3+18.4) ng/L, (1.3) ng/L, respectively. The concentration of SOD at T2 and T3 were (65.3 + 9.0) U/L and (58.8 + 8.5) U/L, respectively, which were significantly higher than that at T0 (P < 0.05). The concentration of SOD at T2 and T3 was (65.3 + 9.0) U/L and (58.8 + 8.5) U/L, which were significantly lower than that at T0 (P < 0.05). The IL-6/IL-10 ratio of propofol group was lower than that of T0 at each time point, while the IL-6/IL-10 ratio of sevoflurane group was higher than that of T0 at T2 and T3 (P < 0.05). Compared with sevoflurane group, there was no significant difference in the propofol group at T1 (P > 0.05); the concentration of IL-10 and SOD in propofol group at T2 and T3 increased significantly (P < 0.05), while the concentration of IL-6 and MDA decreased significantly (P < 0.05). The IL-6/IL-10 ratio of sevoflurane group at T1, T2 and T3 were higher than that of propofol group at corresponding time points (P < 0.05). Conclusion Propofol anesthesia maintain was more conducive to maintaining with pro-inflammatory cytokines and anti-inflammatory cytokines balance, oxidation and antioxidant balance in patients undergoing one-lung ventilation. It may protect the lung from the injury during one-lung ventilation. |
| Key words: Propofol sevoflurane one-lung ventilation lung protection |
