七氟醚预处理对单肺通气患者脑氧饱和度、肺顺应性及全身应激反应的影响

Effect of sevoflurane pretreatment on cerebral oxygen saturation,pulmonary compliance and systemic stress response in patients with one-lung ventilation

目的:探讨七氟醚预处理对单肺通气患者脑氧饱和度、肺顺应性及全身应激反应的影响。方法:收集2012年1月~2015年12月间在本院接受择期肺叶切除术的肺癌患者70例,按照单盲随机对照法分为观察组及对照组,各35例。在常规麻醉诱导后,对照组接受空氧混合通气,观察组接受七氟醚预处理30min,其后均开始单肺通气。麻醉诱导后即刻(T0)、七氟醚预处理后30 min(T1)、七氟醚预处理后60min(T2)、术毕胸壁缝合时(T3),采用脑氧饱和度监测仪测定两组左侧、右侧局部脑氧饱和度(rSO2);根据呼气末气道阻断法及气道相关指标计算健侧肺静态顺应性(Cst)、肺动态肺顺应性(Cdyn);采用放射免疫法测定血清应激激素含量。结果:T0时,两组脑氧饱和度、肺顺应性及全身应激反应差异无统计学意义(P>0.05);T1、T2、T3时,观察组左侧、右侧rSO2水平高于对照组,Cst、Cdyn水平均显著高于对照组,血清肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)含量低于对照组(P<0.05)。结论:七氟醚预处理可提升单肺通气患者术中脑氧饱和度及肺顺应性,减轻全身应激反应。

Objective：To investigate the effect of sevoflurane pretreatment on cerebral oxygen saturation,pulmonary compliance and systemic stress response in patients with one-lung ventilation.Methods：A total of 70 patients with lung cancer who accepted the selective pulmonary lobectomy in our hospital between January 2012 and December 2015 were collected and divided into observation group and control group（n=35）according to the single-blind randomized control method.After general anesthesia induction,the control group received air/oxygen mixed ventilation,and the observation group received sevoflurane pretreatment for 30 min and received one-lung ventilation after that.Immediately after anesthesia induction（T0）,30 min after sevoflurane pretreatment（T1）,60 min after sevoflurane pretreatment（T2）and at chest wall suture after operation（T3）,the cerebral oxygen saturation monitor was used to determine the left and right regional cerebral oxygen saturation（rSO2）;end-expiratory airway blocking method and related indexes were used to calculate the contralateral pulmonary static compliance（Cst）and pulmonary dynamic compliance（Cdyn）;the RIA method was used to determine serum stress hormone levels.Results：At T0,differences in cerebral oxygen saturation,pulmonary compliance and systemic stress response were not statistically significant between two groups of patients;at T1,T2 and T3,left and right rSO2 levels of observation group were higher than those of control group,Cst and Cdyn levels were significantly higher than those of control group,and serum epi-nephrine（E）,norepinephrine（NE）,cortisol（Cor）and angiotensinⅡ（AngⅡ）levels were lower than those of control group.Conclusions：Sevoflurane pretreatment can promote the intraoperative cerebral oxygen saturation and pulmonary compliance,and reduce systemic stress response in patients with one-lung ventilation.