文章摘要
通气侧肺前列腺素E1雾化吸入对单肺通气患者氧合的影响
Effect of prostaglandin E1 nebulization inhalation on oxygenation in patients during one-lung ventilation
  
DOI：10.12089/jca.2022.06.003
中文关键词: 单肺通气  吸入氧浓度  前列腺素E1  雾化吸入
英文关键词: One-lung ventilation  Inspired oxygen fraction  Prostaglandin E1  Nebulization inhalation
基金项目:江苏省肿瘤医院优才基金（YC201805）；江苏省麻醉重点实验室开放课题（XZSYSKF2019024）；“六个一工程”拔尖人才项目 （LGY2019076）
作者单位E-mail
张民皓 210009,南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院麻醉科  
顾连兵 210009,南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院麻醉科  
李彭依 210009,南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院麻醉科  
焦点 210009,南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院麻醉科  
宋田皓 210009,南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院麻醉科  
潘旋 210009,南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院麻醉科  
王丽君 210009,南京医科大学附属肿瘤医院,江苏省肿瘤防治研究所,江苏省肿瘤医院麻醉科 11337212@qq.com 
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中文摘要:
      
目的 探讨通气侧肺前列腺素E1（PGE1）雾化吸入预给药对食管癌患者FiO2 50%单肺通气（OLV）期间机体氧合的影响。
方法 选择拟行左剖胸食管癌根治术的患者113例，男92例，女21例，年龄18~79岁，BMI＜30 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为四组：PGE1 0.1 μg/kg组（P1组，n=29）、PGE1 0.2 μg/kg组（P2组，n=29）、PGE1 0.3 μg/kg组（P3组，n=30）和生理盐水对照组（C组，n=25）。麻醉平稳改右侧卧位后，P1组、P2组和P3组分别给予右侧肺PGE1 0.1、0.2和0.3 μg/kg（以生理盐水稀释至10 ml）雾化吸入，C组给予右侧肺生理盐水10 ml雾化吸入，雾化吸入时间均为10 min。记录术前PaO2、手术时间、OLV时间、术中出血量、尿量、输液量。分别于全麻后右侧卧位时（T0）、OLV 10 min（T1）、OLV 15 min（T2）、OLV 30 min（T3）、OLV 60 min（T4）、OLV 120 min（T5）抽取桡动脉血和右颈内静脉血各2 ml，采样后立刻行血气分析，计算肺内分流率（Qs/Qt），记录T0—T5时PaO2、PaCO2、PETCO2、MAP、HR、Ppeak。于T0、T4、OLV结束恢复双肺通气30 min（T6）及术后24 h（T7）抽取中心静脉血，采用ELISA法检测血清白细胞介素-6(IL-6)和肿瘤坏死因子-α（TNF-α）浓度。记录术后第2天临床肺部感染评分（CPIS），记录术后7 d内肺不张、吻合口瘘等肺部并发症的发生情况以及ICU停留时间、总住院时间。
结果 四组术前PaO2、手术时间、OLV时间、术中出血量、尿量、输液量差异无统计学意义。T1—T3时 P3组Qs/Qt明显低于其余三组，PaO2明显高于其余三组（P<0.05）；P2组Qs/Qt明显低于P1组和C组，PaO2明显高于P1组和C组（P<0.05）；P1组Qs/Qt明显低于C组，PaO2明显高于C组（P<0.05）。T4时 P1组、P2组和P3组Qs/Qt明显低于C组，PaO2明显高于C组（P<0.05）；P3组Qs/Qt明显低于P1组，PaO2明显高于P1组（P<0.05）。T1、T2时P3组MAP明显低于C组（P<0.05）。T4、T6、T7时P1组、P2组和P3组血清IL-6、TNF-α浓度明显低于C组（P<0.05）。P1组、P2组和P3组CPIS评分明显低于C组（P<0.05）。四组术后肺不张、吻合口瘘发生率、ICU停留时间、总住院时间差异无统计学意义。
结论 在FiO2 50%的条件下，于双肺通气期间预先给予OLV期间的通气侧肺雾化吸入PGE1，可以通过降低肺内分流率而改善氧合，以保证机体氧供（该效应在OLV 10、15、30 min时呈明显的剂量依赖性），同时降低患者围术期血清IL-6和TNF-α浓度。
英文摘要:
      
Objective To investigate the effect of prostaglandin E1(PGE1) nebulization inhalation on oxygenation during one lung ventilation (OLV) in patients with esophageal cancer undergoing thoracotomy under FiO2 50%.
Methods A total of 113 patients undergoing radical esophagectomy for left thoracotomy, 92 males and 21 females, aged 18-79 years, BMI < 30 kg/m2, ASA physical status Ⅱ or Ⅲ, were selected and randomly divided into four groups by random number table method: PGE1 0.1 μg/kg group (group P1, n = 29), PGE1 0.2 μg/kg group (group P2, n = 29), PGE1 0.3 μg/kg group (group P3, n = 30) and normal saline control group (group C, n = 25). After the anesthesia was stable and changed to the right lateral position, groups P1, P2, and P3 were given PGE1 0.1, 0.2, and 0.3 μg/kg (diluted to 10 ml with normal saline) nebulization inhalation in the right lung respectively, and group C was given normal saline 10 ml nebulization inhalation in the right lung for 10 minutes. Preoperative PaO2, operation time, OLV time, intraoperative bleeding, urine volume and infusion volume were recorded. Radial artery blood 2 ml and right internal jugular vein blood 2 ml were taken after the anesthesia was stable and changed to the right lateral position (T0), OLV 10 minutes (T1), OLV 15 minutes (T2), OLV 30 minutes (T3), OLV 60 minutes (T4) and OLV 120 minutes (T5), and blood gas analysis was performed immediately after sampling. Intrapulmonary shunt rate (Qs/Qt) was calculated. PaO2, PaCO2, PETCO2, MAP, HR, and Ppeak at T0-T5 were recorded. The central venous blood was collected at T0, T4, 30 minutes after two lung ventilation was restored (T6) and 24 hours after operation (T7), and the concentration of serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA). The clinical pulmonary infection score (CPIS) was recorded on the second day after operation, the occurrence of pulmonary complications such as atelectasis and anastomotic fistula within 7 days after operation, the length of stay in ICU, and the total length of hospital stay were recorded.
Results There were no significant differences in preoperative PaO2, operation time, OLV time, intraoperative bleeding, urine volume, and infusion volume between the four groups. At T1-T3, the Qs/Qt in group P3 was significantly lower than that in the other three groups, the PaO2 was significantly higher than that in the other three groups (P < 0.05), the Qs/Qt in group P2 was significantly lower than that in groups P1 and C, the PaO2 was significantly higher than that in groups P1 and C (P < 0.05), the Qs/Qt in group P1 was significantly lower than that in group C, and the PaO2 was significantly higher than that in group C (P < 0.05). At T4, the Qs/Qt in groups P1, P2, and P3 was significantly lower than that in group C, and the PaO2 was significantly higher than that in group C; the Qs/Qt in group P3 was significantly lower than that in group P1, and the PaO2 was significantly higher than that in group P1 (P < 0.05). MAP in group P3 was significantly lower than that in group C at T1 and T2 (P < 0.05). The concentrations of serum IL-6 and TNF-α in groups P1, P2, and P3 were significantly lower than that in group C at T4, T6, and T7(P < 0.05). The postoperative CPIS in groups P1, P2, and P3 was significantly lower than that in group C (P < 0.05). There were no significant differences in the incidences of postoperative atelectasis, anastomotic fistula, ICU stay, and total hospital stay among the four groups.
Conclusion Under the condition of FiO2 50%, nebulization inhalation of prostaglandin E1 during bilateral rentilation can improve oxygenation by reducing the intrapulmonary shunt rate dose-dependently at OLV 10, 15, and 30 minutes, and reduce the perioperative serum inflammatory factors IL-6 and TNF-α.
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