【作者】 夏斌；

【导师】 张孟元；

【作者基本信息】 山东大学 ， 麻醉学， 2009， 硕士

【摘要】 目的:观察术中需行单肺通气的食管癌患者肺复张诱导的肺组织氧化应激损伤以及空气肺复张的保护作用。方法:选取32例ASAⅠ～Ⅱ级,择期行食管癌切除、胃食管吻合术的患者。按照手术当中实施单肺通气与否、单肺通气时间长短以及使用纯氧或空气膨肺,分为以下4组,每组8名患者:A组:术中不实施单肺通气,采用小潮气量通气和间断的手控呼吸。术毕关胸前使用纯氧膨肺。B组:单肺通气时间小于120min,术毕关胸前使用纯氧膨肺。C组:单肺通气时间大于120min,术毕关胸前使用纯氧膨肺。D组(治疗组)单肺通气时间大于120min,术毕关胸前使用空气膨肺。每组采用统一的术前用药、麻醉用药和检测手段。分别于T1:麻醉诱导成功后单肺通气前(A组为麻醉诱导后开胸前)、T2:单肺通气转为双肺通气前(A组为膨肺之前)、T3:单肺通气转为双肺通气后5min(A组为膨肺后5min)采取动脉血5ml迅速离心,取上层血浆于-70℃超低温冰箱保存,测定血中MDA、SOD、IL-6、IL-8、TNF-α以及蛋白羰基水平作为氧化应激指标。并在T1时间点与术后24h(T4)采动脉血做血气分析,检测PaO2、PaCO2并计算PaO2/FiO2以评估肺功能。结果:蛋白羰基、SOD和MDA水平在A组各时间点无显著差异(p＞0.05),在B、C、D组T3时间点蛋白羰基和MDA水平显著增高、SOD水平显著降低,且变化程度C＞B＞D(p＜0.05):IL-6、IL-8和TNF-α水平在各组T2时间点显著增高,且C=D＞B＞A(p＜0.05)。术后24小时各组氧合指数显著降低,且变化程度C＞B＞D＞A(p＜0.05)。结论:胸科手术术中单肺通气会导致氧化应激反应的发生,这一过程主要发生在肺复张的环节。氧化应激损伤的严重程度与单肺通气时间的长短有关,单侧肺萎陷时间越长的患者,肺复张后氧化应激损伤越严重。使用空气进行肺复张会减轻氧化应激损伤,具有肺保护作用。更多还原

【Abstract】 Objectives :To observe the oxidative stress injury induced by lung expation during one-lung ventilation in esophageal cancer patients and the protective effect of air conducted lung expansion.Methods:32 patients of esophageal cancer receiving selective surgery ASA grade I-II were divided into four groups , each group include 8 patients . Group A : To these patients , no one-lung ventilation was applied during surgery , and the lung expansion was conducted by pure oxygen . Group B : For these patients , one-lung ventilation applied during surgery was less than 120 minutes and the lung expansion was conducted by pure oxygen . Group C : For these patients , one-lung ventilation applied during surgery was more than 120 minutes and the lung expansion was conducted by pure oxygen . Group D (Treatment group) : For these patients , one-lung ventilation applied during surgery was more than 120 minutes and the lung expansion was conducted by air . Other methods of anaesthesia , medication and monitoring were all the same in each group . Blood samples were collected for each patient at : T1 - after one-lung ventilation was established; T2 - just before the lung expansion ; T3 - 5 minutes after the lung expansion . Those blood samples were collected for the measurement of MDA , SOD , IL-6 , IL-8 , TNF-αand plasma protein carbonyl levels as the indicators of oxidative stress injury. And a artery blood sample was taken to detect the oxygenation index 24 hours after the surgery as a indicator of lung function .Results : The levels of plasma protein carbonyl and MDA were significantly higher in group B , C and D at T3 , and with the level of SOD significantly lower .The extent of variation C>B>D . (p<0.05) The levels of IL-6 , IL-8 , TNF-αwere significantly higher in all groups ,with the extent of variation C=D>B>A .(p<0.05) The oxygenation index was significantly lower in all groups ,with the extent of variation C>B>D>A .(p<0.05)Conclusions : One-lung ventilation will cause oxidative stress injury, especially during lung expansion . Air conducted lung expansion will reduce the extent of oxidative stress injury and protect lung function .更多还原