胸段硬膜外阻滞复合七氟醚麻醉对兔缺氧性肺损伤时炎症因子的影响

Effects of combined sevoflurane-epidural anesthesia on inflammatory factors in rabbits with hypoxic lung injury

目的观察胸段硬膜外阻滞复合七氟醚麻醉对兔缺氧性肺损伤时炎症因子的影响。方法健康新西兰大白兔28只,随机分为4组(n=7):对照组(C组)、缺氧组(H组)、七氟醚组(S组)和硬膜外复合七氟醚组(ES组)。ES组硬膜外导管首剂注入1%利多卡因3mg/kg,此后每小时追加该剂量。麻醉后气管插管,机械通气,H组、S组和ES组吸入14%的氮氧混合气体,直至PaO2/FiO2<300,急性肺损伤(ALI)模型建立,并于自主呼吸(T0),模型建立后15min、30min、1h、2h和3h(T1-5)测PaO2。C组始终吸21%的氧气,并于相应时点测PaO2。于T0和T5时抽右颈动脉血5mL,测血清IL-6、IL-8和IL-10浓度。结果H组、S组和ES组在缺氧15min后建立急性肺损伤模型。H组T5时的IL-6和IL-8分别为(94.1±15.1)和(59.5±14.9)pg/mL,S组此时的IL-6和IL-8分别为(90.2±17.3)和(53.9±8.7)pg/mL,均较T0时显著升高(P<0.05)。两组T5时的IL-10分别为(24.9±7.6)和(25.2±4.9)pg/mL,较T0时显著降低(P<0.05)。ES组T5时的IL-6为(56.2±19.9)pg/mL,显著低于H组和S组(P<0.05),较C组无显著差异(P>0.05),H组和S组该时点的IL-6浓度显著高于C组(P<0.05)。结论胸段硬膜外阻滞复合七氟醚麻醉可抑制兔缺氧性肺损伤时的炎症反应。

Objective To evaluate the effect of combined sevoflurane-epidural anesthesia on inflammatory factors in rabbits with hypoxic lung injury. Methods Twenty-eight New Zealand white rabbits of either sex were randomly divided into 4 groups with 7 animals in each group：control group （group C） ,hypoxia group （group H）, sevoflurane group （group S） and combined sevoflurane-epidural anesthesia group （group ES）. In group ES,The catheter was inserted at T5,6 interspace and advanced 1 cm into the epidural space cephalad, 1% lidocaine was injected after the epidural block was confirmed by epidurography, followed by injection of the same dose every one hour. The rabbits were anesthetized with 30 mg/kg pentobarbital by intravenous infusion and then tracheotomized and intubated, finally they were mechanically ventilated （group H,S and ES：FiO2, = 14% ,group C：FiO2 = 21% ,Vt= 10-12 mL/kg,Rr=25 bpm,I：E = 1：2） . The acute lung injure （ALl） model was considered to have been induced successfully after PaO2/FiO2〈300. Three hours after reaching the AI.I standard,all animals recovered spontaneous breathing （FiO2 = 21% ）. Arterial bloodgases were measured during spontaneous breathing （T0〉） （baseline）,at 15 min,30 min,1h,2 h and 3 h after ALI was induced （T1-s） in group H,S and ES and at the corresponding mechanically ventilation time in group C. Arterial blood 5 mL were obtained in all groups at T0, and T5 in order to measure serum IL-6, IL-8 and IL-10. Results ALI model was induced at 15 min after hypoxia in group H,S and ES. IL-6 and IL-8 at T5 in group H was （94. 1± 15. 1 ）and （59.5 ± 14.9） pg/mL respectively. IL-6 and IL-8 at Ts in group S was （90. 2 ± 17.3） and （53.9 ± 8.7）pg/mL respectively. They were all significantly higher than those at T, and those in group C （P〈0. 05）. IL-10 at T5 in group H and S was （24.9 ± 7.6） and （25.2± 4.9） pg/mL respectively. They were significantly higher than those at T, （P〈0. 05）. IL-6 at T5 in group ES was （56.2 ± 19.9） pg/mL,which were significantly lower than those in group H and S （P〈0. 05）. Conclusions Combined sevoflurane-epidural anesthesia can attenuate the inflammatory reaction in rabbits with hypoxic lung injury.