单侧肺通气时肺功能、血管紧张素Ⅱ与白介素-8的变化及意义

The study on the changes in plasma Ang Ⅱ and IL-8 of one-lung ventilated patients

目的 :研究单肺通气时血管紧张素 和 IL - 8的变化及其临床意义。方法 :选择 15例 ASA ～ 择期需单肺通气开胸手术的食道癌患者 ,以快诱导全凭静脉普鲁卡因合并异丙酚麻醉 ,双腔支气管导管插管。呼吸参数设定 :VT:7m L / kg,Rf:12次 /分～ 14次 /分 ,I/ E:1/ 2。选择双肺通气 (TL V ) 30 m in和单肺通气 (OL V ) 15 min、30 min、6 0m in、12 0 min为观测时间点。观测气道压 (Ppeak)、肺顺应性 (C)、呼气末二氧化碳分压 (PETCO2 )、外周血血管紧张素 (Ang )、白介素 - 8(IL- 8)的变化。结果 :OL V与 TL V比较肺功能变化有显著差异。Ppeak增加 (P<0 .0 5 ) ,C降低 (P<0 .0 5 )。 PETCO2 总体比较无差异 (P>0 .0 5 ) ,但组内比较有差异。 OL V时间延长 ,Ang 水平降低 (P<0 .0 5 ) ,IL- 8变化不明显 (P>0 .0 5 )。结论 :随 OL V时间延长 ,外周血 Ang 水平下降 ,但恢复 TL V后可逆转 ;OL V期间 ,IL- 8变化不明显 ,说明 OL V对肺组织影响轻微。关于上述变化的机制以及随时间延长 IL- 8是否有变化值得进一步研究。

Objective:This study investigated the changes in plasma AngⅡand IL 8 of one lung ventilated patients.Methods:After anesthesia induction,fifteen patients of esophageal cancer ASA grade Ⅰ～Ⅱ was intubated with left sided double lumen endobroncheal tube.Controlled ventilation was performed with Ohmeda Anesthetic System(Excel 210 SE).Respiratory parameter settings were:V T 7 mL/kg,RR 12bpm,I:E 1:2.The measurements were made for Ang Ⅱ,IL 8,P peak ,C(Compliance),P ET CO 2,at separate occasions:30 min of Two lung ventilation,15 minutes,30 minutes,60 minutes and 120 minutes after one lung ventilation.All data was analyzed with SPSS 10.0.Results:The Ang Ⅱ was decreased during one lung ventilation(OLV, P< 0.05),while IL 8 showed no changes( P >0.05)。Conclusions:Under OLV anesthesia Ang Ⅱ was decreased.Further study was invited for investigation of the mechanisms.