帕瑞昔布钠预先给药对食管癌根治术患者单肺通气时肺内分流的影响

Effect of parecoxib pretreatment on intrapulmonary shunt during one-lung ventilation in patients undergo- ing esophageal cancer resection

目的评价帕瑞昔布钠预先给药对食管癌根治术患者单肺通气时肺内分流的影响。方法择期行食管癌根治术患者4｜D例，性别不限，年龄25～64岁，ASA分级Ⅰ或Ⅱ级，体重45～70h，身高156—178cm。采用随机数字表法，将患者随机分为2组（n=20）：生理盐水组（NS组）和帕瑞昔布钠组（P组）。麻醉前30min，P组静脉注射帕瑞昔布钠40mg（生理盐水稀释至10m1），NS组静脉注射等容量生理盐水。随后两组依次静脉注射丙泊酚、芬太尼、罗库溴铵行麻醉诱导，气管插管后放人支气管阻塞器，纤维支气管镜确定阻塞器位置准确后行机械通气。静脉输注丙泊酚、瑞芬太尼，间断静脉注射阿曲库铵维持麻醉。于双肺通气5min（T0）、单肺通气40min（T1）、恢复双肺通气30min（T2）时测定HR、MAP、Sp02和气道平均压（Pmean），同时采集颈内静脉和桡动脉血样，行血气分析，计算肺内分流率（Qs／Qt），记录动脉血氧分压（PaO2）。结果两组血液动力学指标和Pmean比较差异无统计学意义（P〉0．05）。与T0时比较，两组T1,2时PaO2降低，Qs／Qt升高（P〈0．05）；与T1时比较，两组T2时PaO2升高，Qs／Qt降低（P〈0．05）；与Ns组相比，P组T1,2时Qs／Qt降低，T2时PaO2升高（P〈O．05）。结论麻醉前30min静脉注射帕瑞昔布钠40mg可减少食管癌根治术患者单肺通气时肺内分流。

Objective To investigate the effects of parecoxib pretreatment on the intrapulmonary shunt during one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA Ⅰ or Ⅱ pa- tients of both sexes, aged 25-64 yr, weighing 45-70 kg, with body height 156-178 era, undergoing elective esoph- ageal surgery, were randomly divided into2 groups （ n = 20 each） ： normal saline group （group NS） and parecoxib group （group P）. Parecoxib 40 mg （in normal saline 10 ml） was injected intravenously 30 min before anesthesia in group P, while the equal volume of normal saline was given instead of parecoxib in group NS. Anesthesia was in- duced with iv injection of propofol, fentanyl and rocuronium. Bronchial blocker was inserted after tracheal intuba- tion and the correct position was confirmed by brenchoscopy. Anesthesia was maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of atracurium. HR, MAP, SpO2 and mean airway pressure （Pmean） were determined at 5 min of two-lung ventilation, at 40 min of one-lung ventilation, and at 30 min after re-expan- sion of the collapsed lung （T0-2）. Blood samples were taken simultaneously from jugular vein and radial artery for blood gas analysis. Intrapulmonary shunt （Qs/Qt） was calculated. Results There were no significant differences in hemodynamic parameters and Pmo= between the two groups （ P 〉 0.05） . PaO2 was significantly lower, while Qs/Qt was significantly higher at T1,2 than at To in groups NS and P （P 〈 0.05）. PaO2 was significantly higher, while Qs/Qt was significantly lower at T2 than at % in groups NS and P （P 〈 0.05）. Qs/Qt was significantly lower at T1,2 and PaO2 was significantly higher at T2 in group P than in group NS （ P 〈 0.05 ）. Conclusion Parecoxib 40 mg injected intravenously at 30 min before anesthesia can reduce the intrapulmonary shunt during one-lung ven- tilation in patients undergoing esophageal cancer resection.