高滲氯化鈉溶液對術中單肺通氣時肺保護作用_《華西醫學》

作者：

金濤 , 黎旭 , 袁芳

遂寧市第一人民醫院麻醉科（四川遂寧，629000）;

關鍵詞：

高滲氯化鈉溶液單肺通氣氧合指數呼吸指數肺順應性肺保護

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【摘要】　目的　通過觀察單肺通氣患者術中氧合指數（oxygenation index，OI）、呼吸指數（respiratory index，RI）及動態肺順應性（dynamic lung compliance，Cdyn）的變化，探討高滲氯化鈉溶液對術中單肺通氣患者的肺保護作用。　方法　選擇2009年12月-2011年2月完成的美國麻醉師協會分級為Ⅰ~Ⅲ級，心肺功能篩查、血常規、肝腎功能及凝血功能無明顯異常，擬在全麻雙腔氣管插管下行開胸手術，術中需行單肺通氣患者60例，隨機分為高滲氯化鈉組（A組）和對照組（B組），每組30例。A組在開始單肺通氣后30 min快速輸注7.5%高滲氯化鈉溶液2 mL/kg，15 min內輸注完畢，B組輸注等量生理鹽水，分別記錄輸注前（T1）、輸注完畢時（T2）、輸注后30 min（T3）、輸注后1 h（T4）的OI、RI及Cdyn變化，并比較兩組各時間點生命體征變化。　結果　兩組患者OI、RI及Cdyn在T1、T2時差異無統計學意義（P gt;0.05）；兩組患者不同時間點平均動脈壓、心率、脈搏血氧飽和度、中心靜脈壓、呼氣末CO2分壓比較差異無統計學意義（P gt;0.05）；A組患者在T3、T4時的OI和Cdyn較B組明顯升高，RI明顯降低（P lt;0.05）；且A組患者在T3、T4時的OI和Cdyn較T1時明顯增高，RI明顯降低（P lt;0.05）。　結論　高滲氯化鈉溶液能改善術中單肺通氣患者的OI、RI及Cdyn，對肺功能有一定的保護作用。
【Abstract】　Objective　 To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects.　Methods　 Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared.　Results　 OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (P gt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (P gt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (P lt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (P lt;0.05).　Conclusion　 Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.

引用本文： 金濤,黎旭,袁芳. 高滲氯化鈉溶液對術中單肺通氣時肺保護作用. 華西醫學, 2011, 26(8): 1192-1194. doi: 復制

1.	宋俊東, 鄭敏. 高滲鹽溶液對腦損傷的保護作用[J]. 黑龍江醫學, 2006(12): 900-903.
2.	張巖, 智緒亭, 張建民, 等. 高滲鹽水對肝臟缺血再灌注損傷保護作用的臨床研究[J]. 中國現代普通外科進展, 2009, 12(4): 313-316.
3.	柯慶宏, 鄭樹森, 梁廷波, 等. 高滲鹽水預處理可減輕中性粒細胞介導的肝臟缺血再灌注損傷[J]. 中國病理生理雜志, 2007, 23(7): 1326-1330.
4.	劉紅, 韓洪偉, 馬聚峰, 等. 高滲鹽水對大鼠肢體缺血再灌注致心肌損傷的保護作用[J]. 寧夏醫學雜志, 2007, 29(12): 1059-1060.
5.	蔡秀軍, 牟一平. 高滲鹽水治療未控制出血的失血性休克動物實驗及臨床觀察[J]. 中國普外基礎與臨床雜志, 1998, 5(1): 14-15.
6.	Ishikawa, Seijia B, Lohser, et al. One-lung ventilation and arterial oxygenation[J]. Curr Opin Anaesthesiol, 2011, 2(24): 24-31.
7.	Moutafis M, Liu N, Dalibon N, et al. The effects of inhaled nitric oxide and its combination with intravenous almitrine on PaO2 during one-lung ventilation in patients undergoing thoracoscopic procedures[J]. Anesth Analg, 1997, 85(5): 1130-1135.
8.	任光國, 周允中. 胸外科手術并發癥的預防和治療[M]. 北京: 人民衛生出版社, 2004: 474.
9.	Yada-langui MM, Anjos-valotta EA, Sannomiya P, et al. Resuscitation affects microcirculatory polymorphonuclear leukocyte behavior after hemorrhagic shock:role of hypertonic saline and pentoxifylline[J]. Exp Biol Med(Maywood), 2004, 229(7): 684-693.
10.	周其全, 支東學. 高滲鹽水對低氧條件下失血性休克時肺損傷的保護作用[J]. 中華實驗外科雜志, 1994, 11(5): 299-300.
11.	Poli-de-figueiredo LF, Cruz RJ, Sannomiya P, et al. Mechanisms of action of hypertonic saline resuscitation in severe sepsis and septic shock[J]. Endocr Metab Immune Disord Drug Targets, 2006, 6(2): 201-206.
12.	Ghafari MH, Moosavizadeh SA, Moharari RS, et al. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock[J]. Middle East J Anesthesiol, 2008, 19(6): 1337-1347.
13.	Lewis FR, Elings VB, Hill SL, et al. The measurement of extravascular lung water by thermal-green dye indicator dilution[J]. Ann N Y Acad Sci, 1982, 384: 394-410.

1. 　宋俊東, 鄭敏. 高滲鹽溶液對腦損傷的保護作用[J]. 黑龍江醫學, 2006(12): 900-903.
2. 　張巖, 智緒亭, 張建民, 等. 高滲鹽水對肝臟缺血再灌注損傷保護作用的臨床研究[J]. 中國現代普通外科進展, 2009, 12(4): 313-316.
3. 　柯慶宏, 鄭樹森, 梁廷波, 等. 高滲鹽水預處理可減輕中性粒細胞介導的肝臟缺血再灌注損傷[J]. 中國病理生理雜志, 2007, 23(7): 1326-1330.
4. 　劉紅, 韓洪偉, 馬聚峰, 等. 高滲鹽水對大鼠肢體缺血再灌注致心肌損傷的保護作用[J]. 寧夏醫學雜志, 2007, 29(12): 1059-1060.
5. 　蔡秀軍, 牟一平. 高滲鹽水治療未控制出血的失血性休克動物實驗及臨床觀察[J]. 中國普外基礎與臨床雜志, 1998, 5(1): 14-15.
6. 　Ishikawa, Seijia B, Lohser, et al. One-lung ventilation and arterial oxygenation[J]. Curr Opin Anaesthesiol, 2011, 2(24): 24-31.
7. 　Moutafis M, Liu N, Dalibon N, et al. The effects of inhaled nitric oxide and its combination with intravenous almitrine on PaO2 during one-lung ventilation in patients undergoing thoracoscopic procedures[J]. Anesth Analg, 1997, 85(5): 1130-1135.
8. 　任光國, 周允中. 胸外科手術并發癥的預防和治療[M]. 北京: 人民衛生出版社, 2004: 474.
9. 　Yada-langui MM, Anjos-valotta EA, Sannomiya P, et al. Resuscitation affects microcirculatory polymorphonuclear leukocyte behavior after hemorrhagic shock:role of hypertonic saline and pentoxifylline[J]. Exp Biol Med(Maywood), 2004, 229(7): 684-693.
10. 　周其全, 支東學. 高滲鹽水對低氧條件下失血性休克時肺損傷的保護作用[J]. 中華實驗外科雜志, 1994, 11(5): 299-300.
11. 　Poli-de-figueiredo LF, Cruz RJ, Sannomiya P, et al. Mechanisms of action of hypertonic saline resuscitation in severe sepsis and septic shock[J]. Endocr Metab Immune Disord Drug Targets, 2006, 6(2): 201-206.
12. 　Ghafari MH, Moosavizadeh SA, Moharari RS, et al. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock[J]. Middle East J Anesthesiol, 2008, 19(6): 1337-1347.
13. 　Lewis FR, Elings VB, Hill SL, et al. The measurement of extravascular lung water by thermal-green dye indicator dilution[J]. Ann N Y Acad Sci, 1982, 384: 394-410.

《華西醫學》

高滲氯化鈉溶液對術中單肺通氣時肺保護作用

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《華西醫學》

高滲氯化鈉溶液對術中單肺通氣時肺保護作用

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Content

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