文章摘要
甲基强的松龙对肺叶切除术患者单肺通气时肺功能和炎症反应的影响
Effects of methylprednisolone on lung function and inflammation during one lung ventilation in patients undergoing pulmonary lobectomy
  
DOI：
中文关键词: 甲强龙  单肺通气  肺功能  炎症反应
英文关键词: Methylprednisolone  One-lung ventilation  Lung function  Inflammation
基金项目:国家自然科学基金 (81503080);安徽省自然科学基金 (1608085QH210);安徽省公益性技术应用研究联动计划项目 (1604f0804019)
作者单位E-mail
许辉 230001,合肥市,安徽医科大学附属省立医院麻醉科  
疏树华 230001,合肥市,安徽医科大学附属省立医院麻醉科 sshhf@189.cn 
王迪 230001,合肥市,安徽医科大学附属省立医院麻醉科  
柴小青 230001,合肥市,安徽医科大学附属省立医院麻醉科  
潘建辉 230001,合肥市,安徽医科大学附属省立医院麻醉科  
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中文摘要:
      目的 探讨甲基强的松龙（甲强龙）对肺叶切除术患者单肺通气时肺功能和炎症反应的影响。方法 选择择期拟行肺叶切除术患者60例，男46例，女14例，年龄18～60岁，ASA Ⅰ或Ⅱ级，采用随机数字表法分为两组:甲强龙组 (M组)和对照组 (C组)，每组30例。M组于麻醉诱导前30 min静脉注射甲强龙2 mg/kg，C组于相同时点静脉注射等量生理盐水。分别记录单肺通气前 (T0)、单肺通气30 min (T1)、单肺通气1 h (T2)、恢复双肺通气10 min (T3)及术毕 (T4)时的MAP、气道峰压 (Ppeak)、气道平台压 (Pplat)及动态肺顺应性 (Cdyn)，并于上述时间点抽取桡动脉血行血气分析，检测PaO2和PaCO2，计算氧合指数 (OI)、肺泡-动脉血氧分压差 (A-aDO2)及呼吸指数 (RI)。分别于T0、T4、术后6 h (T5)及术后24 h (T6)采集中心静脉血样，采用ELISA法检测血清TNF-α、IL-6及IL-10的浓度。记录术后72 h肺部并发症的发生情况。结果 与T0时比较，T1、T2时两组MAP、Cdyn明显降低，Ppeak、Pplat明显升高 (P<0.05);T1～T4时OI明显降低，A-aO2、RI明显升高 (P<0.05);T4～T6时血清TNF-α、IL-6及IL-10浓度明显升高 (P<0.05)。与C组比较，T1、T2时M组Ppeak、Pplat明显降低，Cdyn明显升高 (P<0.05);T4～T6时M组血清TNF-α、IL-6浓度明显降低，IL-10浓度明显升高 (P<0.05)。两组患者术后72 h肺部并发症发生率差异无统计学意义。结论 甲强龙可有效改善肺叶切除术患者单肺通气时动态肺顺应性，优化呼吸动力学，减轻机体炎症反应，但对肺氧合及换气功能无明显影响。
英文摘要:
      Objective To investigate the effects of methylprednisolone on lung function and inflammation during one-lung ventilation in patients undergoing pulmonary lobectomy. Methods Sixty patients (46 males, 10 females, aged 18-60 years, ASA grade Ⅰ or Ⅱ) scheduled for pulmonary lobectomy were randomly divided into two groups (n=30 each) using a random number table: the control group (group C) and the methylprednisolone group (group M). Patients in group M were treated with methylprednisolone before induction of anesthesia within 30 min, whereas patients in group G received equal volume of normal saline at the same time. The heart rate (HR), mean arterial pressure (MAP), peak airway pressure (Ppeak), plateau airway pressure (Pplat), and dynamic lung compliance (Cdyn) were recorded at the momment before OLV (T1), 30 min after OLV (T2), 1 h after OLV (T3), 10 min after resuming two-lung ventilation (T4) and the end of the surgery (T5). The arterial blood gas analysis were performed at the above time points in order to determined the oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2), then the oxygenation index (OI), alveolar to arterial difference of oxygen tension (A-aDO2) and respiratory index (RI) of each patient was evaluated. The concentration of serum TNF-α, IL-6 and IL-10 were determined by ELISA at T0, T4, 6 h (T5) and 24 h (T6) after surgery using venous blood samples. The incidence of pulmonary complications at 72 h after operation were also recorded. Results Compared with T0, the MAP and Cdyn was decreased, whereas the Ppeak and Pplat was increased significantly in both group at T1, T2 (P<0.05), the OI was decreased and the A-aDO2, RI was increased significantly at T1-T4 (P<0.05), and the concentration of serum TNF-α, IL-6 and IL-10 at T4-T6 was increased significantly in both group (P<0.05). Compared with group C, the Cdyn was increased, the Ppeak and Pplat were decreased significantly in group G at T1, T2 (P<0.05), the concentration of serum TNF-α and IL-6 were decreased, and IL-10 was increased significantly in group G at T4-T6 (P<0.05). The incidence of postoperative pulmonary complications had no statistically signifcant differences between the two groups. Conclusion Methylprednisolone can significantly improve the pneumodynamics and lung compliance, alleviates the inflammatory responses, but have no significant effect on intrapulmonary oxygenation and gas exchange during one lung ventilationin patients undergoing pulmonary lobectomy.
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