七氟烷和异丙酚麻醉对肺癌切除术患者围术期炎性反应及肺功能影响的比较

Effects of sevoflurane versus propofol anesthesia on inflammatory response and pulmonary function during perioperative period in patients undergoing lung cancer resection

目的 比较七氟烷和异丙酚麻醉对肺癌切除术患者围术期炎性反应及肺功能的影响.方法 选择单纯性左肺下叶切除术患者30例,ASA Ⅰ或Ⅱ级,性别不限,年龄41～64岁,体重指数22～30 kg/m2,随机分为2组（n=15）：七氟烷组（S组）和异丙酚组（P组）.S组吸入6%～8%七氟烷,静脉注射维库溴铵0.1 mg/kg、芬太尼4～6μg,kg行麻醉诱导,吸入1%～3%七氟烷维持麻醉;P组静脉注射异丙酚2 mg/kg、维库溴铵0.1 mg/kg、芬太尼4～6μg/kg行麻醉诱导,静脉输注异丙酚6～10 nag·kg-1·h-1维持麻醉.于麻醉诱导前（T0）、单肺通气开始前（T1）、单肺通气结束（T2）、关胸（T3）、术后24 h（T4）时取桡动脉血样和混合静脉血样行血气分析,计算肺泡-动脉氧分压差（PA-aO2）、呼吸指数（RI）和肺内分流率（Qs/Qt）;于T0、T3、T4时取桡动脉血样,测定血清基质金属蛋白酶-9（MMP-9）和MDA的浓度;于T1、T2、T3时计算肺动态顺应性（Cd）.结果 与T0时比较,T1-3,时两组PA-a,O2、RI和Qs/Qt升高,T3时血清MMP-9和MDA浓度升高（P〈0.05）;与T1时比较,T3时S组Cd降低（P〈0.05）;与P组比较,S组T3时PA-a O2、血清MMP-9和MDA的浓度升高,T2,3时RI、T1～3时Qs/Qt升高（P〈0.05）.结论 与七氟烷麻醉比较,肺癌切除术患者采用异丙酚麻醉时围术期炎性反应较低,肺功能损伤相对较轻.

Objective To compare the effects of sevoflurane and propofol anesthesia on inflammatory response and pulmonary function during perioperative period in patients undergoing lung cancer resection.Methods Thirty ASA Ⅰ or Ⅱ patients（23 male,7 female） aged 41-64 yr having a body weisht index of 22-30 kg/m2 undegoing elective left lower lobe resection were randomly divided into 2 groups（n=15 each）：sevoflurane group （group S） and propofol group（group P）.Anesthesia was induced with 6%-8% sevoflurane or propofol 2 mg/kg and fentanyl 4-6 μg/kg.Intubation with double lumen catheter was facilitated with vecuroniunl 0.1 mg/kg. Anesthesia was maintained with 1%-3% sevoflurane/propofol infusion（6-10 mg·kg-1·h-1）and intermittent iv boluses of fentanyl and vecuronium.Radial artery was cannulated.Swan-Ganz catheter was placed via right internal jugular vein.The patients were mechanically ventilated.During one lung ventilation（OLV）I：E and VT were adjusted to maintain airway pressure 〈30 cm H2O.Arlerial and mixed venous blood samples were collected for blood gas analysis before induction of anesthesia（T0）,before OLV（T1）,at the end of OLV（T2）,when the chest was closed（T3） and at 24 h after operation （T4）.PA-aO2,Qs/Qt and respiratory index（RI,PA-aO2/PaO2） were calculated. Serum matrix metallo-proteinase-9 （MMP-9） and MDA were measured at T0, T3 and T4. Dynamic lung compliance （Cd） was calculated at T1-3 .Results PA-aO2, RI and Qs/Qt at T1-3 and serum MMP-9 and MDA concentrations at T3 were significantly increased as compared with the baseline values at T0 in both groups. In group S, Cd was significantly lower at T3 than at T1.PA-AO2, and serum MMP-9 and MDA concentrations at T3, RI at T2,3 and Qs/Qt at T1-3 were significantly higher in group S than in group P. Conclusion The inflammatory response is lower and the injury to pulmonary function is lighter during propofol anesthesia than sevoflurane anesthesia in patients undergoing lung cancer resection.