七氟烷和丙泊酚对食管癌单肺通气患者术中和术后肺氧合功能的影响及机制

Effects and Mechanism of Sevoflurane and Propofol on Patients with Esophageal Cancer of One Lung Ventilation of Pulmonary Oxygenation During and After Operation

关键词:  七氟烷  丙泊酚  单肺通气  肺氧合功能  麻醉

Key words:  sevoflurane  propofol  one lung ventilation  oxygenation  anesthesia

摘要:

目的 分析七氟烷和丙泊酚对食管癌单肺通气患者术中和术后肺氧合功能的影响及机制。方法 选取90例胸外科食管癌单肺通气患者，ASA分级为Ⅰ~Ⅱ级，随机分为对照组与研究组各45例。对照组给予丙泊酚静脉注射，研究组给予七氟烷维持麻醉。比较2组术中与术后心率、平均动脉压、吸气峰压及脉搏氧饱和度等指标，采集2组血标本，测定其氧合指数。采用免疫组织化学法检测2组NF-κB表达水平，并记录2组并发症的发生情况。结果 2组患者术中与术后心率、平均动脉压、吸气峰压及脉搏氧饱和度比较，均无明显差异（P均>0.05）；研究组术中与术后动脉血氧分压及氧合指数均明显高于对照组（P均<0.05），而2组术中与术后动脉血二氧化碳分压比较，均无明显差异（P>0.05）；研究组肺组织中NF-κB水平低于对照组，且术后呼吸困难的发生率明显低于对照组（P<0.05）。研究组其他并发症发生率稍低于对照组，但均无明显差异。结论 相比丙泊酚，七氟烷能够有效改善食管癌单肺通气患者肺氧合功能，其机制可能与抑制NF-κB表达有关。

Abstract:

OBJECTIVE To analyze the effects and mechanism of sevoflurane and propofol on patients with esophageal cancer of one lung ventilation in department of thoracic surgery of pulmonary oxygenation during and after operation. METHODS The 90 cases of esophageal cancer with one lung ventilation of thoracic surgery were selected, whose ASA grade were I-Ⅱ, which were randomly divided into the control group and the study group, with 45 cases in each group. The control group were given intravenous propofol, while the study group were given sevoflurane for anesthesia. The heart rate, mean arterial pressure, peak inspiratory pressure and pulse oxygen saturation were compared between the two groups. The oxygenation index of the two groups were measured after collecting blood samples. The expression of NF-κB in two groups were detected by immunohistochemistry, and the complications of the two groups were recorded. RESULTS The levels of heart rate, mean arterial pressure, peak inspiratory pressure and pulse oxygen saturation during and after operation showed no significant difference between the two groups (P all>0.05); the levels of intraoperative and postoperative pulse oxygen saturation and oxygenation index in the study group were significantly higher than those in the control group (P all<0.05), while the levels of intraoperative and postoperative arterial partial pressure of carbon dioxide showed no significant difference between the two groups (P all>0.05). The NF-κB level of lung tissue was lower than that of the control group and the incidence rate of postoperative respiratory difficulties was significantly lower than that of the control group (P<0.05), while the incidence rate of other complications showed no significant difference between the two groups (P all>0.05). CONCLUSION Compared with propofol, sevoflurane can significantly improve the oxygenation function of patients with esophageal cancer of one lung ventilation, and the mechanism may be raleted to the inhibition of NF-κB expression.