七氟醚和异丙酚对单肺通气致缺血-再灌注损伤保护作用的比较
Comparison of the Effects of Sevoflurane and Propofol on One Lung Ventilation Induced Ischemia-Reperfusion Injury
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摘要: [摘要]目的 研究比较七氟醚和异丙酚对单肺通气致缺血-再灌注损伤保护作用.方法 36例胸外科手术单肺通气患者随机分成2组:七氟醚组和异丙酚组.七氟醚组:硫喷妥钠诱导+1%~2.5%七氟醚加40%/60% O2/N2O混合气吸入维持麻醉.异丙酚组:丙泊酚诱导+异丙酚和瑞芬太尼静脉输注维持麻醉.在麻醉诱导前(T1)、双肺通气前1 min(T2)、双肺通气30 min后(T3)和术后第 6 h(T4)各时间点,记录血流动力学参数和抽取血液样本测定血气变化、缺血修饰白蛋白(IMA)水平和丙二醛(MDA)含量.结果 在T2、T3时在异丙酚组患者心率低于七氟醚组, 差异无统计学意义(P >0.05),2者在PCO2和pH值差异无统计学意义(P>0.05).在T2、T3时七氟醚组患者PO2明显低于异丙酚组(P <0.05).在T4时,七氟醚组患者IMA水平和MDA含量低于异丙酚组(P <0.05).结论 七氟醚能够对胸外科手术单肺通气患者的缺血-再灌注损伤提供保护作用.Abstract: [Abstract]Objective To investigate and compare the effects of sevoflurane and propofol on one lung ventilation (OLV) induced ischemia-reperfusion injury. Methods Thirty-six patients undergoing thoracic surgery with OLV were randomized in two groups: sevoflurane group(Group S,n = 18 )and propofol group( Group P,n = 18). Anesthesia was inducted with thiopental and was maintained with 1-2.5% of sevoflurane within the 40/60% of O2/N2O mixture in Group S. In Group P,anesthesia was inducted with propofol and was maintained with infusion of propofol and remifentanil. Hemodynamic parameters were monitored and blood samples were obtained before anesthesia induction(T 1), 1 min before two lung ventilation(T 2),30 min after two lung ventilation(T 3), and postoperative sixth hours(T 4). Blood samples for the blood gas,ischemia-modified albumin(IMA),and malonyldialdehyde(MDA)were mensurated .Results Heart rate at T 2 and T3 in Group P was lower than that in Group S,but there was no difference(P>0.05).While there was no significant difference in terms of pCO2 and pH(P >0.05).pO2 at T2 and T3 in Group S was significantly lower than that in Group P(P <0.05). IMA levels and MDA contents at T 4 in Group S were significantly lower than those in Group P(P <0.05). Conclusion Sevoflurane may offer protection against ischemia-reperfusion injury after OLV in thoracic surgery.
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