瑞芬太尼对单肺通气患者炎症反应和氧合功能的影响

Effects of remifentanil on inflammatory responses and oxygenation during one lung ventilation

目的观察瑞芬太尼对单肺通气患者炎症反应和氧合功能的影响。方法择期开胸手术行单肺通气患者30例，按照随机排列表分为生理盐水对照组（C组）和瑞芬太尼治疗组（R组），每组15例。两组患者在单肺通气前1min（T1），单肺通气结束后3min（T2）及其后30min（T3）各时间点进行动脉血气分析及计算肺内分流率（QslQt）和氧合指数值（PaO2/FiO2），并采取颈内静脉血测定细胞因子及炎性介质的活性。结果同T1时相比：C组Qs／Qt在T2、T3时显著升高（P〈O．05）[（15．1±4．6）％vs．（11．5±3．4）％，（16．7±3．9）％VS．（11．5±3．4）％]，而PaO2/FiO2在T2、L时显著下降（P〈0．05）[（397±95）mmHgVS．（471±69）mmHg，（384±78）mmHgVS．（471±69）mmHg]（1mmHg=0．133kPa）；R组Qs／Qt在R时显著升高（P〈O．05）[（14．5±2．3）％vs．（11．8±2．5）％]，PaO2/FiO2在T2时显著下降（P〈0．05）[（410±45）mmHgVS．（465±50）mmHg]。同T2时相比：R组Qs／Qt在L时显著下降（P〈0．05）[（12．0±2．3）％VS．（14．5±2．3）％]，而PaO2/FiO2显著升高（P〈0．05）[（460±45）mmHgVS．（410±45）mmHg]。组间比较：R组Qs／Qt在T3时较C组显著下降（P〈0．05）[（12．0±2.3）％VS．（16．7±3．9）％]，而PaO2/FiO2显著升高（P〈0．05）[（460±45）mmHg vs．（384±78）mmHg]。两组中性粒细胞在T2、T3时显著升高（P〈0．05），R组超氧化物歧化酶（SOD）在T2、B时显著高于C组（P〈0．05）[（58±4）U／mlVS．（53±7）U／ml，（57±5）U／ml vs．（50±9）U／ml]，而丙二醛（MDA）、细胞间黏附分子-1（ICAM-1）显著低于C组（P〈0．05）；R组肿瘤坏死因子-α（TNF-α）在L时显著低于C组（P〈0．05）。相关分析表明：TNF咀和ICAM-1，PaO2/FiO2和SOD，Qs／Qt和MDA有一定的相关性（P〈0．05）。结论瑞芬太尼对单肺通气患者炎症反应和氧合功能具有一定的保护作用。

Objective To observe the effects of remifentanil on inflammatory responses and oxygenation induced by one lung ventilation （OLV）. Methods Thirty patients undergoing one lung ventilation during thoracic surgery were randomly divided into control （C） and remifentanil （R） group, which were treated with saline or remifentanil respectively. Blood samples of arterial and jugular vein were taken 1 min before OLV （T1）, 3 min after completion of OLV （T2）, and 30 min after T2 （T3）, for detecting blood gas analysis, serum levels of neutrophil, superoxide dismutase （SOD）, malondialdehyde （MDA）, intercellular adhesion molecule-1 （ICAM-I）, and tumor necrosis factor-α （TNF-α） Results Compared to those at T1, intrapulmonary shunt （Qs/Qt） increased significantly [ （ 14.5 ±2.3 ）% vs. （ 11.8 ±2.5 ）%, （ 15.1 ±4.6 ）% vs. （ 11.5 ±3.4 ）fro ] and oxygen index （PaO2/FiO2） decreased significantly [（410±45） mm Hg vs. （465~50） mm Hg, （397±95） mm Hg vs.（471±69） mm Hg] （1 mm Hg=0.133 kPa） in control group. Qs/Qt was higher and PaO2/FiO2 was lower at T2 than those at T1 in group R（P〈0.05） [ （14.5±2.3）fro vs. （11.8±2.5）fro, （410±45） mm Hg vs. （465±50） mm Hg];Qs/Qt was lower and PaO2/FiO2 was higher at T3 than those at T2 in group R （P〈 0.05）[（12.0±2.3）% vs. （14.5±2.3）%, （460±45） mm Hg vs.（410±45） mm Hg]. Qs/Qt was lower and PaO2/FiO2 was higher at T3 in group R than those in group C （P〈O.05） [（12.0±2.3）% vs. （16.7±3.9）%, （460±45） mm Hg vs. （384±78） mm Hg]. Serum SOD content in group R was higher than that in group C at T2 and T3 （P〈0.05）. While MDA and ICAM-1 level were significantly decreased in group R than those in group C, serum TNF-α was lower at T3 in group R than those in group C （P〈0.05）. Further analysis showed that there is positive correlation between PaO2/FiO2 and SOD （P〈0.05）, Qs/Qt and MDA （P〈0.05）, TNF-α and ICAM-1 （P〈0.05）. Conclusions Remifentanil has protective effects on inflammatory responses and oxygenation during one lung ventilation.