丙泊酚联合七氟烷对单肺通气患者氧化应激及肺保护效应的影响

Effects of Propofol Combined with Sevoflurane on Oxidative Stress and Lung Protective Effect in Patients with Single Lung Ventilation

目的:观察丙泊酚联合七氟烷对单肺通气患者氧化应激及肺保护效应的影响。方法:择期行胸腔镜肺叶切除术的肺癌患者106例随机分为3组:对照A组(35例)采用七氟烷麻醉,对照B组(35例)采用丙泊酚麻醉,研究组(36例)采用丙泊酚联合七氟烷麻醉。比较3组单肺通气前(T1)、单肺通气30 min时(T2)、单肺通气60 min时(T3)、单肺通气结束时(T4)血流动力学[心率(HR)、平均动脉压(MAP)]、呼吸力学[潮气量(VT)、气道平均压(Pmean)、气道峰压(Ppeak)、肺顺应性(Cdyn)]等指标变化,以及3组T1、T4肺损伤指标[血清克拉拉细胞分泌蛋白16(CC16)、表面活性蛋白(SP-D)]、血气指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)]、氧化应激指标[血清丙二醛(MDA)、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)]及炎症反应因子[血清肿瘤坏死因子α(TNF-α)、高迁移率族蛋白1(HMGB1)、高级糖基化终末产物可溶性受体(sRAGE)]变化,统计3组并发症发生情况和预后情况。结果:研究组、对照B组T2~T4时HR、MAP、Cdyn高于对照A组,Pmean、Ppeak低于对照A组(P<0.05);研究组T4时血清CC16、SP-D、MDA、PaCO2、TNF-α、HMGB1、sRAGE低于对照A组、对照B组,CAT、SOD、PaO2高于对照A组、对照B组(P<0.05);研究组苏醒时间、拔管时间、定向力恢复时间短于对照A组、对照B组(P<0.05)。结论:肺癌患者胸腔镜肺叶切除术单肺通气期间给予丙泊酚联合七氟烷麻醉,能有效降低血流动力学波动,改善呼吸力学,且能减轻氧化应激反应及炎症反应,降低肺损伤,发挥更佳肺保护效应,有助于提高麻醉安全性,改善预后。

Objective: To explore the effects of propofol combined with sevoflurane on oxidative stress and lung protective effect in patients with single lung ventilation. Methods: Totally 106 patients with lung cancer undergoing elective thoracoscopy lobectomy were randomly divided into 3 groups. The control group A( 35 cases) was anesthetized with sevoflurane,the control group B( 35 cases) was anesthetized with propofol,and the study group( 36 cases) was anesthetized with propofol combined with sevoflurane. The hemodynamics [heart rate( HR),mean arterial pressure( MAP) ] and the respiratory mechanics [tidal volume( VT),mean airway pressure( Pmean),peak airway pressure( Ppeak),dynamic pulmonary compliance( Cdyn) ] of the three groups were compared before onelung ventilation( T1),one-lung ventilation 30 min( T2),one-lung ventilation 60 min( T3),and one-lung ventilation end( T4),and compared the lung injury indicators [serum Clara cell secreted protein 16( CC16),surfactant protein D( SP-D) ],blood gas indicators[arterial partial pressure of oxygen( PaO2),partial arterial carbon dioxide pressure( PaCO2) ],oxidative stress indicators[serum malondialdehyde( MDA),catalase( CAT),superoxide dismutase( SOD) ]and inflammatory response factors [serum tumor necrosis factor α( TNF-α),high mobility group box 1( HMGB1),and solubility ofadvanced glycation end products( sRAGE) ] at T1 and T4 in the three groups,and the incidence of complications was recorded and compared as well. Results: The HR and MAP of T2-T4 in the study group and the control group B were higher than those in the control group A( P<0.05);Pmean and Ppeak of the study group and the control group B at T2-T4 were lower than those of the control group A,and Cdyn was higher than that of the control group A( P<0.05);serum CC16 and SP-D levels in the study group at T4 were lower than those in the control group A and the control group B( P<0.05);PaO2 in the study group was higher than that in the control group A and the control group B at T4,and PaCO2 was lower than that in the control group A and the control group B( P<0.05);the serum MDA of the study group at T4 was lower than that of the control group A and the control group B,and CAT and SOD were higher than those of the control group A and the control group B( P<0.05);the serum TNF-α,HMGB1 and sRAGE levels in the study group at T4 were lower than those in the control A and B groups( P<0.05);the recovery time,extubation time and orientation recovery time of the study group were shorter than those of the control group A and the control group B( P<0.05).Conclusion: Anesthesia with propofol combined with sevoflurane during thoracotomy lobectomy for lung cancer patients can effectively reduce hemodynamic fluctuations and improve respiratory mechanics,which can reduce oxidative stress,inflammatory responses and lung injury,and play a better lung protective effect,and help to improve anesthesia safety and prognosis.