无呼吸性气流通气对单肺通气患者术侧肺的保护作用

Protective effect of apneic oxygen insufflation on operated lung of patients undergoing one-lung ventilation

目的评价无呼吸性气流通气对单肺通气(OLV)患者术侧肺的保护作用。方法择期胸科手术患者54例,性别不限,年龄50~75岁,ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n=27):常规组(C组)和无呼吸性气流通气组(A组)。麻醉诱导后行双腔气管导管插管术。A组OLV即刻于术侧肺行无呼吸性气流通气,持续以5L/min给氧,氧浓度100%。分别于OLV前1min(T1)、OLV结束后3、33min(T2、T3)时,采集桡动脉血样进行血气分析,计算氧合指数和肺内分流率,记录T3时氧合指数<200及300mmHg的发生情况。采集颈内静脉血样,检测血清肺表面活性物质相关蛋白质B、肺表面活性物质相关蛋白质C(SP-B、SP-C)浓度。T3时行术侧肺支气管肺泡灌洗术,采用酶联免疫法检测支气管肺泡灌洗液SP-B、SP-C浓度。结果与C组比较,A组T2、T3时氧合指数升高,肺内分流率降低,血清SP-B、SP-C浓度降低,支气管肺泡灌洗液SP-B、SP-C浓度升高(P<0.05)。结论OLV期间对术侧肺予以5L/min无呼吸性气流通气可减轻术侧肺损伤。

Objective To evaluate the protective effect of apneic oxygen insufflation on the operated lung of patients undergoing one-lung ventilation (OLV). Methods Fifty-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 50-75 yr, scheduled for elective pulmonary tumorectomy, were divided into 2 groups using a random number table method: conventional group (group C, n=27) and apneic oxygen insufflation group (group A, n=27). The patients were intubated with a double-lumen tube after induction of anesthesia.Apneic oxygen insufflation was performed on the operated lung immediately after OLV by continuously administrating oxygen at 5 L/min with inspiratory oxygen fraction of 100%.Blood samples were taken from the radial artery at 1 min before OLV (T1) and 3 and 33 min after OLV (T2, 3) for blood gas analysis, pulmonary oxygenation index and intrapulmonary shunt rate were calculated, and the occurrence of oxygen index less than 200 and 300 mmHg was recorded.Blood samples of the internal jugular vein were collected to detect the concentrations of surfactant protein B (SP-B) and surfactant protein C (SP-C) in serum.The lung on the operated side was lavaged at T3, and the broncho-alveolar lavage fluid was collected for determination of the concentrations of SP-B and SP-C by enzyme-linked immunosorbent assay. ResultsCompared with group C, the oxygenation index was significantly increased at T2, 3, the intrapulmonary shunt rate was decreased, the concentrations of SP-B and SP-C in serum were decreased, and the concentrations of SP-B and SP-C in broncho-alveolar lavage fluid were increased in group A (P<0.05). Conclusion Giving apneic oxygen insufflation 5 L/min to the operated lung during OLV can reduce the damage to the operated lung.