脂微球前列腺素E_1对控制性降压患者动脉氧分压及肺内分流影响

Effects of lipo-prostaglandin E_1 Lipo-PGE_1 on arterial oxygen partial pressure and intropulmonary shunt inpatients with controlled hypotension

目的观察脂微球前列腺素E1对硝普钠控制性降压患者手术期间动脉氧分压及肺内分流影响。方法择期行鼻内窥镜手术患者40例,分为脂微球前列腺素E1组(P组)和对照组(C组),每组20例。P组持续静脉泵注脂微球前列腺素E12 ng/(kg.min),C组以同样容积速率泵入生理盐水。分别于输注硝普钠前,降压30、60 min,停止硝普钠输注复压后20 min时分别取动脉血和右心房血做血气分析并记录监测数据。结果两组患者在不同采样点组间MAP、HR、pH值无显著性差异(P>0.05);与降压前比较,两组降压30、60 min时Qs/Qt升高,PaO2降低(P<0.05);组间比较降压30、60 min、复压后3点,P组PaO2高于C组(P<0.05),Qs/Qt仅在复压后P组高于C组(P<0.05);组内比较,C组复压后PaO2低于降压前(P<0.05)。结论脂微球前列腺素E1可以改善硝普钠控制性降压所引起动脉氧合变化,对降压期间肺内分流和血流动力学无明显影响,复压后可改善肺内分流。

Objective To explore the influence of Lipo-PGE1 on the arterial oxygen partial pressure and pulmonary shunt fraction in controlled hypotension patients with SNP.Methods 40 patients receiving endoscopic sinus surgery were randomly divided into Group P（Lipo-PGE1） and Group C（control group）,each of 20 patients.Group P received an injection of Lipo-PGE1 of 2 ng/（kg·min） and Group C only received an injection of same amount of saline.The arterial and right atrium blood were taken for blood gas analysis before SNP infusion,30 min and 60 min after SNP infusion,and 20 min after BP restoration.Results MAP,HR,pH were not statistically different in the two groups（P0.05）.Qs/Qt was increased and PaO2 was decreased 30 min and 60 min after SNP infusion compared with before SNP infusion in the two groups.PaO2 in Group P was significantly higher than that in Group C（P0.05） 30 min and 60 min after SNP infusion,and 20 min after BP restoration.Qs/Qt of Group P was significantly higher than that in Group C（P0.05） only after BP restoration.In each of groups PaO2 was significantly lower after BP restoration than that before SNP infusion（P0.05）.Conclusions Lipo-PGE1 may improve the level of arterial oxygenation after controlled hypotension with SNP and has no effect on Qs/Qt and vital signs during controlled hypotension.But it may reduce Qs/Qt after BP restoration.