文章摘要
七氟醚和丙泊酚对危重患儿肺功能影响的比较
Comparison of pulmonary function between sevoflurane and propofol in critically ill children
  
DOI：10.12089/jca.2022.11.004
中文关键词: 丙泊酚  七氟醚  儿童  肺功能  髓系细胞表达触发受体-1
英文关键词: Propofol  Sevoflurane  Children  Pulmoanry function  Triggering receptor-1 expressed in myeloid cells
基金项目:国家自然科学基金（82060024）；广西医学高层次骨干人才培养 “139”计划（G202002015）；2019年广西医疗卫生重点学科（麻醉学科），广西壮族自治区妇幼保健院育苗计划（GXWCH-YMJH-2018005）
作者单位E-mail
罗诚 530000,南宁市,广西壮族自治区妇幼保健院麻醉科  
莫健兰 530000,南宁市,广西壮族自治区妇幼保健院麻醉科  
荆忍 广西医科大学附属肿瘤医院麻醉科  
王晓夏 530000,南宁市,广西壮族自治区妇幼保健院麻醉科  
吕锋 530000,南宁市,广西壮族自治区妇幼保健院麻醉科  
吕凯敏 530000,南宁市,广西壮族自治区妇幼保健院麻醉科  
冯继峰 530000,南宁市,广西壮族自治区妇幼保健院麻醉科 604282082@qq.com 
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中文摘要:
      
目的 观察七氟醚和丙泊酚对危重患儿肺功能的影响。
方法 选择行腹部手术合并肺炎危重患儿64 例，男39例，女25例，日龄1～28 d，体重2～5 kg，ASA Ⅲ级。采用随机数字表法将患儿分为两组：七氟醚吸入麻醉组（S组）和丙泊酚静脉麻醉组（P组），每组32例。记录插管后30 min、术毕、术后6 h的氧合指数（OI）、肺泡动脉氧分压差（PA-aO2）、呼吸指数（RI）、血清髓系细胞表达触发受体-1（TREM-1）、白细胞介素-8（IL-8）浓度。记录低氧血症、心律失常、严重感染、新生儿呼吸窘迫、无法纠正的低血压等围术期不良事件的发生情况。
结果 与插管后30 min比较，S组术毕、术后6 h OI明显升高，PA-aO2和RI明显降低（P<0.05）；P组术毕OI、术后6 h PA-aO2明显降低（P＜0.05）。与术毕比较， S组术后6 h OI明显升高，RI明显降低（P＜0.05），P组术后6 h PA-aO2明显降低（P＜0.05）。与P组比较，术毕、术后6 h S组OI明显升高，RI明显降低，术后6 h PA-aO2明显升高（P＜0.05）。两组不同时点血清TREM-1浓度差异无统计学意义。与术毕比较，P组术后6 h血清IL-8浓度明显降低（P＜0.05）。与P组比较，S组术毕、术后6 h血清IL-8浓度明显降低（P＜0.05）。两组患儿均无围术期不良事件发生。
结论 与丙泊酚比较，七氟醚能够降低危重患儿血清炎性因子IL-8浓度，对危重患儿具有肺保护作用。
英文摘要:
      
Ojective To observe the effect of sevoflurane versus propofol on pulmonary function in critically ill children.
Methods Sixty-four critically ill children with pneumonia undergoing abdominal operation, 39 males and 25 females, aged 1-28 days, weighing 2-5 kg, ASA physical status Ⅲ, were included. They were randomly divided into sevoflurane inhalational anesthesia group (group S) and propofol intravenous anesthesia group (group P) using random number table method, 32 children in each group. Oxygenation index (OI), alveolar arterial oxygen differential pressure (PA-aO2), and respiratory index (RI) were recorded at 30 minutes after intubation, end of operation, and 6 hours after operation. Serum concentrations of triggering receptor-1 expressed in myeloid cells (TREM-1) and interleukin-8 (IL-8) at 30 minutes after intubation, end of operation, and 6 hours after operation were assessed. The incidence of perioperative adverse events including hypoxemia, arrhythmia, severe infection, neonatal respiratory distress, uncorrectable hypotension was recorded.
Results Compared with 30 minutes after intubation, OI at the end of operation and 6 hours after operation were both increased, while PA-aO2 and RI were significantly declined in group S (P < 0.05); OI at the end of operation and PA-aO2 6 hours after operation were both decreased in group P (P < 0.05). Compared with the end of operation, OI 6 hours after operation were increased, while RI were decreased in group S (P < 0.05), PA-aO2 6 hours after operation were decreased in group P (P < 0.05). Compared with group P, OI at the end of operation and 6 hours after operation were improved, while RI were decreased, PA-aO2 6 hours after operation was increased in group S (P < 0.05). There was no significant difference in the serum concentration of TREM-1 at each point between the two groups. Compared with the end of operation, serum IL-8 concentration 6 hours after operation were decreased in group P (P < 0.05). Compared with group P, serum IL-8 concentration at the end of operation and 6 hours after operation were significantly decreased in group S (P < 0.05). There were no perioperative adverse events occurred between the two groups.
Conclusion Compared with propofol, sevoflurane reduces of serum IL-8 concentration, and has an established lung protective effect for the critically ill children.
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