单肺通气联合硬膜外镇痛对食道癌围术期肺内分流和氧化应激反应及心肌酶的影响

Influence of single lung ventilation combined with outside hard membrane to ease pain on esophageal carcinoma in perioperative period

目的通过检测单肺通气联合硬膜外镇痛对食道癌围术期肺内分流和氧化应激及心肌酶的影响，探讨全麻单肺通气联合硬膜外阻滞镇痛对食道癌手术安全的影响。方法本研究选择120例无明显心肺疾病的50-70岁的患者，随机分成2组，每组60例。工组采用单侧肺通气静脉全麻复合连续硬膜外阻滞，Ⅱ组采用静脉气管插管全麻，连续监测MAP、MPAP,cch、ECG、HR、sP02。2组诱导和维持的药物均为芬太尼、宜妥利、顺苯阿曲库铵。静脉维持为丙泊芬、瑞芬太尼、顺苯阿曲库铵。2组都行颈内静脉置管，同时行桡动脉穿刺置管分别于麻醉前（T1）、进入胸腔后（I组进入胸腔时才单肺通气，Ⅱ组围术期都是双肺通气）10min（T2）、60min（T3）、关胸后（关胸时I组再次双肺通气）30min（T4）及术后24h（T5）抽取动脉、混合静脉血血样，测定血气和肺内分流率（Qs／Qt），测定血清超氧化物歧化酶（SOD）、丙二醛（MDA）及NO浓度及血浆中白细胞介素-8（IL-8）浓度及肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）活性。结果I组与Ⅱ组相比，单肺通气时肺内分流和血气明显变化（P〈0．05），SOD、MDA及IL-8升高（P〈0．01），NO、CK、CK—MB无明显变化。结论单肺通气时肺内分流及血气将发生显著变化，但在可控的合理的范围。血清超氧化物歧化酶（SOD）、丙二醛（MDA）gNO浓度及血浆中白细胞介素-8（IL）浓度升高，肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）活性无明显变化。食道癌围术期行单肺通气联合硬膜外镇痛是安全的。

Objective To discusses the security influence of general anesthesia with single lung ventilation combined with the outside hard membrane to ease pain on esophageal carcinoma operation in perioperative period. Methods A total of 120 esophageal carcinoma patients aged 50-70 years without obvious heart and lungs diseases were randomly divided into two groups （each group of 60 people）. The patients of Group I received the single lung ventilation of vein general anesthesia combined with outside hard membrane to ease pain, and the patients of Group II group underwent the trachea inserting a tube and the vein general anesthesia. MAP, MPAP, CO2, ECG, HR, SPO2 and so on were continuously monitored. Results The comparison between Group I and Group II group showed that when the single lung ventilation, the changes of lung divergence and courage vigor were obvious （P 〈 0.05 ）, and SOD, MDA, and ILo8 were of ascension （P 〈 0.01）. However, the changes of NO, CK, and CK-MB were not obvious. Conclusions When the single lung ventilation, the changes of lung divergence and courage vigor were obvious but in a controllable and reasonable scope. The general anesthesia with single lung ventilation combined with the outside hard membrane to ease pain in esophageal carcinoma operation during perioperative period is safe.