[1]郭佳庆,王晓蕾,常海宽,等.七氟烷后处理对单肺通气下行食管癌根治术患者肺损伤的影响[J].新乡医学院学报,2021,38(3):240-244.[doi:10.7683/xxyxyxb.2021.03.007]
　GUO Jiaqing,WANG Xiaolei,CHANG Haikuan,et al.Effect of sevoflurane postconditioning on lung injury in patients underwent radical resection of esophageal carcinoma with one lung ventilation[J].Journal of Xinxiang Medical University,2021,38(3):240-244.[doi:10.7683/xxyxyxb.2021.03.007]
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七氟烷后处理对单肺通气下行食管癌根治术患者肺损伤的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年3
页码:
240-244
栏目:
临床研究
出版日期:
2021-03-05

文章信息/Info

Title:
Effect of sevoflurane postconditioning on lung injury in patients underwent radical resection of esophageal carcinoma with one lung ventilation
作者:
郭佳庆; 王晓蕾; 常海宽; 高宁宁; 杨明月; 樊　腾; 李晓芳; 张红伟; 胡淋淋; 张文杰; 张　杰; 徐璐丹; 岳修勤
（新乡医学院第一附属医院麻醉科，河南　卫辉　453100）
Author(s):
GUO Jiaqing; WANG Xiaolei; CHANG Haikuan; GAO Ningning; YANG Mingyue; FAN Teng; LI Xiaofang; ZHANG Hongwei; HU Linlin; ZHANG Wenjie; ZHANG Jie; XU Ludan; YUE Xiuqin
(Department of Anesthesiology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
全身麻醉; 单肺通气; 七氟烷后处理; 肺损伤
Keywords:
general anesthesiaone lung ventilationsevoflurane postconditioninglung injury
分类号:
R614.2
DOI:
10.7683/xxyxyxb.2021.03.007
文献标志码:
A
摘要:
目的　探讨单肺通气（OLV）下行食管癌根治术中七氟烷后处理对患者肺损伤的影响。方法　选择2018年8月至2019年8月于新乡医学院第一附属医院择期行食管癌根治术的患者60例为研究对象，按随机数字表法分为对照组和七氟烷组，每组30例。2组患者均采用双腔支气管插管全身麻醉，OLV下行食管癌根治术；七氟烷组患者于OLV结束后给予体积分数10%七氟烷吸入30 min作七氟烷后处理。2组患者麻醉诱导用药相同，术中输注丙泊酚与瑞芬太尼静脉麻醉维持至术毕。分别于麻醉诱导前（T0)、OLV结束后30 min（T1）、OLV结束后4 h（T2）、OLV结束后24 h（T3）采集桡动脉血标本，采用酶联免疫吸附测定法检测血清肿瘤坏死因子-α(TNF-α）、白细胞介素-8（IL-8)、丙二醛（MDA）水平及超氧化物歧化酶（SOD）活性。于T0、T1、T2、T3时采集桡动脉血行血气分析，记录动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、吸入气氧浓度(FiO2)，计算氧合指数（PaO2/FiO2）。结果　T0时,2组患者的血清IL-8、TNF-α、MDA水平及SOD活性比较差异无统计学意义（P＞0.05）。与T0时比较，2组患者T1、T2、T3时的血清IL-8、TNF-α、MDA水平均显著增高(P＜0.05)，SOD活性均显著降低(P＜0.05)。2组患者T1、T2时的血清IL-8、TNF-α、MDA水平显著高于T3时(P＜0.05)，对照组患者T1、T2时的血清SOD活性显著低于T3时(P＜0.05)，七氟烷组患者T1时的血清SOD活性显著低于T3时(P＜0.05)。T1、T2、T3时七氟烷组患者的血清IL-8、TNF-α、MDA水平显著低于对照组(P＜0.05)，SOD活性显著高于对照组(P＜0.05)。2组患者T0、T3时的PaO2比较差异无统计学意义（P＞0.05）；T1、T2时七氟烷组患者的PaO2高于对照组(P＜0.05)。T0、T1、T2、T3时，2组患者的PaCO2比较差异均无统计学意义（P＞0.05）。T0、T3时，2组患者的氧合指数比较差异无统计学意义（P＞0.05）；T1、T2时，七氟烷组患者的氧合指数高于对照组(P＜0.05)。与T0时比较，2组患者T1、T2、T3时的PaCO2均显著增高(P＜0.05)，氧合指数均显著降低(P＜0.05)。与T3时比较，对照组患者T2时的PaCO2显著增高(P＜0.05)，2组患者T1、T2时的氧合指数显著降低(P＜0.05)。结论　七氟烷后处理能抑制OLV下行食管癌根治术患者炎症细胞因子的产生，改善氧合指数，对肺损伤有一定的保护作用。
Abstract:
Objective　To investigate the effect of sevoflurane postconditioning on lung injury in patients underwent radical esophagectomy with one lung ventilation(OLV).Methods　　A total of 60 patients with esophageal cancer underwent selective radical resection in the First Affiliated Hospital of Xinxiang Medical University from August 2018 to August 2019 were selected as observation subjects.They were divided into control group and sevoflurane group according to random number table,with 30 patients in each group.All patients were given double-lumen endobronchial intubation general anesthesia,and the radical esophagectomy was performed under OLV.The patients in the sevoflurane group were given volume fraction 10% sevoflurane inhalation for 30 min after OLV.All patients were given the same anesthesia induction drugs,and the propofol and remifentanil were infused during the operation to maintain anesthesia until the end of operation.Blood samples of radial artery were collected before induction of anesthesia(T0),30 minutes after OLV(T1),4 hours after OLV(T2) and 24 hours after OLV(T3),the levels of serum tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),malondialdehyde (MDA) and the activity of superoxide dismutase(SOD) were measured by using enzyme-linked immunosorbent assay.Radial artery blood of patients at T0,T1,T2 and T3 was collected for blood gas analysis,the partial pressure of oxrgen in artery (PaO2),Partial pressure of carbon dioxide in artery (PaCO2) and inspired oxygen concentration (FiO2) were recorded,and the oxygenation index PaO2/FiO2 was calculated.Results　There was no significant differences in serum IL-8,TNF-α,MDA levels and SOD activity of patients between the two groups at T0(P＞0.05).Compared with T0,the serum levels of IL-8,TNF-α and MDA of patients in the two groups were significantly increased,and the activity of SOD was significantly decreased at T1,T2,T3(P<0.05).The serum levels of IL-8,TNF-α and MDA of patients at T1 and T2 were significantly higher than those at T3 in the two groups(P<0.05).The activity of SOD of patients at T1 and T2 was significantly lower than that at T3 in the control group(P<0.05);the activity of SOD of patients at T1 was significantly lower than that at T3 in the sevoflurane group(P<0.05).The serum levels of IL-8,TNF-α and MDA of patients in the sevoflurane group were significantly lower than those in the control group at T1,T2 and T3(P<0.05),and the activity of SOD was significantly higher than that in the control group(P<0.05).There was no significant difference in PaO2 between the two groups at T0 and T3(P＞0.05).The PaO2 of patients in the sevoflurane group was significantly higher than that in the control group at T1 and T2(P<0.05).There was no significant difference in PaCO2 between the two groups at T0,T1,T2 and T3 (P＞0.05).There was no significant difference in the oxygenation index between the two groups at T0 and T3,(P＞0.05).The oxygenation index of patients in the sevoflurane group was higher than that in the control group at T1 and T2(P<0.05).Compared with T0,the PaCO2 of the patients at T1,T2 and T3 in the two groups were significantly increased(P<0.05),and the oxygenation index was significantly decreased in the two groups(P<0.05).Compared with T3,the PaCO2 of patients at T2 was significantly increased in the control group(P<0.05),and the oxygenation index of patients at T1 and T2 was significantly decreased in the two groups(P<0.05).Conclusion　Sevoflurane postconditioning can inhibit the production of inflammatory cytokines and improve oxygenation index of patients underwent radical esophagectomy under OLV,it has a certain protective effect on lung injury.

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更新日期/Last Update: 2021-03-05