舒芬太尼对单肺通气致肺损伤的影响

Effects of sufentanil on the lung injury induced by one-lung ventilation

目的探讨舒芬太尼对单肺通气（OLV）致肺损伤的影响。方法 60例食管癌根治术患者随机分为两组：SF组术中麻醉用舒芬太尼0.8~1.2μg/kg,术后镇痛48 h用舒芬太尼2μg/kg;C组麻醉用异氟醚诱导和维持,术后镇痛48 h用吗啡3~5 mg。围OLV期取肺泡液测定白细胞介素8（IL-8）和肿瘤坏死因子α（TNF-α）。围术期取静脉血测定血管性假血友病因子（vWF）、血浆可溶性血栓调节蛋白（sTM）。记录苏醒拔管时间、术后视觉模拟评分（VAS）和不良反应。结果与OLV前比较,两组OLV 60 min和恢复双肺通气后30 min时肺泡灌洗液IL-8、TNF-α均明显升高,但SF组肺泡灌洗液IL-8、TNF-α均低于C组（P〈0.05或P〈0.01）;两组OLV和术后48 h的血清vWF、sTM活性均明显升高,但SF组血清vWF、sTM活性均明显低于C组（P〈0.01,P〈0.05）。SF组肺不张、心律失常等发生率明显低于C组（P〈0.01）。结论舒芬太尼对OLV所致肺损伤具有明显保护作用。

Objective To investigate the effects of sufentanil on the lung injury induced by one-lung ventilation（OLV）.Methods Sixty patients underwent esophygeal surgery were divided into two groups with 30 cases each.Group SF was anesthetized with sufentanil 0.8-1.2μg/kg,which was followed by postoperative analgesia with sufentanil 2μg/kg for 48h.Group C was anesthetized with isoflurene inhalation,which was followed by postoperative analgesia with morphine 3-5mg for 48h.Interleukin-8（IL-8） and tumor necrosis factor-α（TNF-α） were detected in bronchoalveolar lavage fluid（BALF） before,at 60min during OLV and 30min after the end of OLV.The activities of von Willebrand factor（vWF） and soluble thrombomodulin（sTM） were mearsured perioperatively.The time of extubation,postoperative VSA score and adverse response were recorded as well.Results The expressions of IL-8 and TNF-α in BALF were increased at 60 min during OLV and 30min after the end of OLV,which were lower in group SF than those in group C（P0.05 or P0.01）.The activities of vWF and sTM were increased during and after operation,which were lower in group SF than those in group C（P0.05 or P0.01）.The incidences of atelectasis and arrhythmia were less in group SF than those in group C（P0.01）.Conclusion Sufentanil has a protective effect on the lung injury induced by OLV.