七氟醚吸入对危重新生儿术中肺表面活性蛋白A和B的影响

Expression of surfactant protein A and B during the operation for critical newborn with sevoflurane inhalation

目的观察吸入七氟醚对危重新生儿术中肺表面活性蛋白A(SPA)和肺表面活性蛋白B(SPB)的影响。方法选择行腹部手术危重新生儿40例,男29例,女11例,出生12~26 d,体重3.0~4.1 kg,ASAⅢ或Ⅳ级,随机分为两组:七氟醚组(S组)和对照组(C组),每组20例。S组于麻醉诱导气管内插管成功后,吸入2.5%七氟醚30 min;C组不予吸入麻醉药物。两组均在超声引导下行颈内静脉和桡动脉穿刺置管术,容量控制机械通气,持续泵入咪达唑仑2μg·kg^-1·min^-1、顺式阿曲库铵2~3μg·kg^-1·min^-1、芬太尼2~4μg·kg^-1·h^-1维持麻醉。记录机械通气开始时(T0)、机械通气开始后30 min(T1)、手术结束即刻(T2)时PaCO2和PaO2,计算呼吸指数(RI)、氧合指数(OI),采用ELISA法检测动脉血血清SPA、SPB和IL-8浓度,记录肺炎、肺气漏、ARDS、颅内出血、DIC、电解质紊乱、切口感染等术后并发症发生情况。结果与T0时比较,T1-T2时两组OI和血清SPA、SPB浓度明显降低(P<0.05),RI和血清IL-8浓度明显升高(P<0.05)。T0时两组RI、OI、血清SPA、SPB和IL-8浓度差异无统计学意义。T1-T2时S组RI和血清IL-8浓度明显低于C组(P<0.05),OI和血清SPA、SPB浓度明显高于C组(P<0.05)。S组术后肺炎发生率明显低于C组(P<0.05)。结论吸入七氟醚能减轻危重新生儿术中炎性介质的释放,改善肺氧合功能,减少术后并发症的发生。

Objective To observe the expression of surfactant protein A and B during the operation for critical newborn with sevoflurane inhalation.Methods Forty critical newborns scheduled for the abdominal surgery with endotracheal intubation after general anesthesia,29 males and 11 females,aged 12-26 days,weighing 3.0-4.1 kg,falling into ASA physical statusⅢorⅣ,were randomly divided into sevoflurane inhalation group(group S,n=20)and control group(group C,n=20).After induction of anesthesia,2.5%sevoflurane was inhalated in group S,while no sevoflurane was inhalated in group C.Both groups were guided under ultrasound during internal jugular vein and radial artery cannulation.During the operation,midazolam 2μg·kg^-1·min^-1,cis-atracuronium 2-3μg·kg^-1·min^-1 and fentanyl 2-4μg·kg^-1·h^-1 were mainlined for maintenance of anesthesia.Both groups were ventilated with volume-controlled mode.PaCO2 and PaO2 were recorded after induction(T0),30 min after mechanical ventilation(T1),and immediately at the end of operation(T2).The respiratory and oxygenation index were calculated according to the blood gas analysis.Furthermore,the arterial blood samples were collected for determination of SPA,SPB and IL-8 with ELISA.Finally,postoperative complications including neonatal pneumonia,lung air leak,acute respiratory distress syndrome,intracranial hemorrhage,disseminated intravascular coagulation(DIC),electrolyte disturbance and infection of incisional wound were evaluated.Results Compared with T0,respiratory index and the concentrations of IL-8 of the two groups were significantly increased,but the oxygenation index and the contents of SPA and SPB was significantly decreased at T1-T2(P<0.05).There were no significant difference between the two groups in SPA,SPB,IL-8 and lung function index at T0.Compared with group C,the oxygenation index,SPA and SPB were significantly higher in group S at T1-T2(P<0.05).The concentrations of IL-8 and respiratory index were significantly lower in group S than in group C(P<0.05).Incidence rate of postoperative neonatal pneumonia was significantly lower in group S than in group C(P<0.05).Conclusion Sevoflurane inhalation in critical newborn can attenuate inflammatory cytokine releasing during the operation,improve the oxygenation function and reduce the postoperative complication.