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七氟醚预处理在单肺通气肺缺血再灌注损伤中的保护作用
Protective effect of sevoflurane preconditioning against lung ischemia-reperfusion injury in patients with one lung ventilation
- 第三军医大学学报 2018年40卷第2期 页码：155-159
- 作者机构：
400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
[ 顾健腾，E-mail: 2448428335@qq.com GU Jianteng, E-mail:2448428335@qq.com
- 基金信息：
DOI：10.16016/j.1000-5404.201709211
中图分类号： R364.12;R614.21;R655收稿：2017-09-28，
修回：2017-11-09，
纸质出版：2018-01-30
- 稿件说明：
移动端阅览
卢孙山, 顾健腾, 鲁开智, 等. 七氟醚预处理在单肺通气肺缺血再灌注损伤中的保护作用[J]. 第三军医大学学报, 2018,40(2):155-159.
Sunshan LU, Jianteng GU, Kaizhi LU, et al. Protective effect of sevoflurane preconditioning against lung ischemia-reperfusion injury in patients with one lung ventilation[J]. Journal of Third Military Medical University, 2018, 40(2): 155-159.
卢孙山, 顾健腾, 鲁开智, 等. 七氟醚预处理在单肺通气肺缺血再灌注损伤中的保护作用[J]. 第三军医大学学报, 2018,40(2):155-159. DOI： 10.16016/j.1000-5404.201709211.
Sunshan LU, Jianteng GU, Kaizhi LU, et al. Protective effect of sevoflurane preconditioning against lung ischemia-reperfusion injury in patients with one lung ventilation[J]. Journal of Third Military Medical University, 2018, 40(2): 155-159. DOI： 10.16016/j.1000-5404.201709211.
摘要
目的
2
探讨七氟醚预处理对单肺通气肺缺血再灌注损伤局部脑氧饱和度、肺顺应性、炎性应激及氧化应激状态的影响。
方法
2
选取2015年10月至2017年7月于本院诊治行肺叶切除术患者88例作为研究对象，依据随机数字表法分为对照组(
n
=44)和观察组(
n
=44)，对照组患者给予丙泊酚麻醉处理，观察组患者在对照组治疗基础上给予七氟醚预处理(单肺通气前预先吸入1.0%~2.0%七氟醚30 min)，比较麻醉诱导前(T
0
)、单肺通气15 min(T
1
)以及双肺通气15 min(T
2
)3个时间点两组患者局部脑氧饱和度(regional cerebral oxygen saturation，rSO
2
)、肺动态顺应性(dynamic lung compliance，Cdyn)、炎性因子[细胞间黏附分子-1(intercellular adhesion molecule -1，ICAM-1)，肿瘤坏死因子-ɑ(tumor necrosis factor-ɑ，TNF-ɑ)
]
与氧化应激水平[超氧化物歧化酶(superoxide dismutase，SOD)，丙二醛(malondialdehyde，MDA)
]
水平。
结果
2
两组T
0
时刻左侧rSO
2
、右侧rSO
2
、Cdyn、ICAM-1、TNF-α、SOD、MDA水平比较，差异无统计学意义(
P
>
0.05);观察组T
1
、T
2
时刻左侧rSO
2
、右侧rSO
2
及Cdyn水平均显著高于对照组(
P
<
0.05)。两组T
1
、T
2
时刻ICAM-1、TNF-α、MDA水平均显著高于T
0
时刻，且T
2
时刻水平显著高于T
1
时刻，观察组T
1
、T
2
时刻水平均显著低于对照组(
P
<
0.05)。与T
0
比较，T
1
、T
2
时刻两组SOD水平均显著降低，且观察组水平显著高于对照组(
P
<
0.05)。
结论
2
七氟醚预处理可有效改善单肺通气肺缺血再灌注患者局部脑缺氧状态和肺顺应性，减轻炎性应激反应，改善患者氧化应激状态。
Abstract
Objective
2
To investigate the effects of sevoflurane preconditioning on regional cerebral oxygen saturation
lung compliance
inflammatory stress and oxidative stress in patients with pulmonary ischemia induced by one lung ventilation.
Methods
2
A
total of 88 patients undergoing pulmonary lobectomy in our hospital between October
2015 and July
2017 were randomized into control group (
n
=44) and observation group (
n
=44). The patients in the control group received propofol anesthesia
and those in the observation group received sevoflurane pretreatment (with inhalation of 1.0%~2.0% sevoflurane for 30 min before one lung ventilation) prior to propofol anesthesia. Before induction of anesthesia (T
0
)
at 15 min during one lung ventilation (T
1
) and at 15 min during double lung ventilation (T
2
)
the regional cerebral oxygen saturation and dynamic lung compliance (Cdyn)
inflammatory factors (ICAM-1 and TNF-α) and oxidative stress index (SOD and MDA) levels were examined and compared between the 2 groups.
Results
2
No statistical differences were found between the 2 groups in left rSO
2
right rSO
2
Cdyn
ICAM-1
TNF-α
SOD
or MDA levels at T
0
(
P
>
0.05). At the time points T
1
and T
2
the levels of left rSO
2
right rSO
2
and Cdyn were significantly higher in the observation group than in the control group (
P
<
0.05). In both groups
the levels of the ICAM-1
TNF-α and MDA at T
1
and T
2
were significantly higher than those at T
0
and their levels were significantly higher at T
2
than T
1
(
P
<
0.05). In the observation group
ICAM-1
TNF-α and MDA levels at T
1
and T
2
were significantly lower than those in the control group at the same time points (
P
<
0.05). Compared with that at T
0
SOD level at T
1
and T
2
were significantly decreased in both groups
and the observation group had significantly higher SOD level than the control group at the 3 time points (
P
<
0.05).
Conclusion
2
Sevoflurane preconditioning can effectively protect against ischemia-reperfusion injury in patients with one lung ventilation by increasing the levels of rSO
2
and Cdyn
relieving inflammatory stress and improving oxidative stress status.
关键词
Keywords
references
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