选择性肺叶隔离对食管手术患者氧化应激反应的影响

Influence of Selective Lobar Blockade on Oxidative Stress Response in Patients Undergoing Esophageal Surgery

目的探讨选择性肺叶隔离（selective lobar blockade，SLB）对食管手术患者氧化应激反应的影响。方法ASAⅠ-Ⅱ级，择期行下段食管手术患者40例，按随机数字表法分为两组：单肺通气（one-lung ventilation，OLV）组和SLB组。OLV组术中需单肺通气时保持右肺通气，左肺萎陷。SLB组术中需单肺通气时保持右肺和左肺上叶通气，左肺下叶萎陷。分别于OLV或SLB前（T1）、30min（T2）、60min（T3）及转为双肺通气后30min（T4）4个时点测定超氧化物歧化酶（superoxide dismutase，SOD）活性、血清丙二醛（malondialdehyde，MDA）含量及动脉血气分析。结果OLV组、SLB组T1时SOD值分别为359±25U／ml、353±27U／ml，MDA值分别为5．7±0．8nmol／ml、5．9±1．0nmol／ml，T4时SOD值分别为206±22U／ml、222±26U／ml，MDA值分别为12．8±1．5nmol／ml、11．7±1．2nmol／ml。与T1时相比，两组T4时SOD降低，MDA升高（P〈0．01）；OLV组、SLB组T1时PaO2分别为316±64mmHg、322±60mmHg，T2时为215±65mmHg、283±59mmHg，T3时为212±58mmHg、270±55mmHg。与T1时相比，两组T2、T3时PaO2均降低（P〈0．05）。与OLV组相比，T4时SLB组SOD值较高（P〈0．05），而MDA值较低（P〈0．05），T2、T3时PaO2较高（P〈0．01）。结论SLB可减轻食管手术患者氧化应激反应的程度。

Objective To evaluate the effect of selective lobar blockade （SLB） on oxidative stress response in patients undergoing e- sophageal surgery. Methods Forty patients,ASA Ⅰ-Ⅱ scheduled for esophageal surgery, were randomly assigned into two groups. Pa- tients in one- lung ventilation（OLV） group received right lung ventilation and left lung collapses. Patients in SLB group received right lung and superior lobe of left lung ventilation, while inferior lobe left lung collapses. The level of superoxide dismutase （SOD） , malondial- dehyde （MDA） and arterial blood gas were analysed at the time before OLV or SLB （ T1 ） ,30minutes （ T2 ） ,60minutes （ T3 ） , and 30minutes after two - lung ventilation（T4 ）, respectively. Results In OLV group and SLB group, the level of SOD at T1 were 359 ± 25U/ml,353 ± 27U/ml, the level of M DA were 5.7 ± 0. 8nmol/ml,5.9 ± 1.0nmol/ml, respectively. The level of SOD at T4 were 206 ± 22U/ml, 222 ± 26U/ml, and the level of MDA were 12.8 ± 1.5nmol/ml, 11.7 ± 1.2nmol/ml, respectively. The level of SOD at T4were significantly lower than that at T1 , and MDA were significantly higher than those at T1 （P 〈 0. 01 ）. In OLV group and SLB group, PaO2 at T1 were 316 ± 64 mmHg,322 ±60 mmHg, at T2 were 215 ±65 mmHg,283 ±59 mmHg, and at T3 were 212 ±58 mmHg,270 ±55 mmHg,respeetively. PaO2 at T2 ,T3 were significantly lower than those at T1 （ P 〈0. 01 or 0. 05 ） in two groups. Compared to OLV group, the level of SOD in SLB group, ere significantly higher, and M DA were significantly lower at T4 （P 〈 0.05 ）. PaO2 in SLB grouper T2 , T3 were significantly higher than those in OLV group （P 〈 0.01 ）. Conclusion The SLB technology could reduce the degree of oxidative stress response in patients undergoing esophageal surgery.