摘要
目的探讨帕瑞昔布钠对单肺通气（OLV）患者肺内分流及氧化应激水平的影响。方法择期食道癌根治术患者30例，年龄42～77岁，体质量41—74kg，ASA分级Ⅰ或Ⅱ级，随机分为两组：对照组（C组，n=15）和帕瑞昔布钠组（P组，n=15）。P组静脉注射帕瑞昔布钠40mg（生理盐水稀释至10mL），C组静脉注射等容量生理盐水。随后两组均靶控输注异丙酚（效应室靶浓度4μg／mL）和舒芬太尼（效应室靶浓度0．3ng／mL）行麻醉诱导，静脉注射罗库溴铵0．9mg／kg，光纤支气管镜引导下插入双腔气管导管，行机械通气。于麻醉诱导开始后30min（T0），OLV 15min（T1）、30min（T2）、1h（T3）、2h（T4），恢复双肺通气30min（T5）、1h（T6）时测定HR、MAP和气道平均压（Pmean）；同时采集颈内静脉和桡动脉血样，进行血气分析以计算肺内分流率（Qs/Qt）；采集桡动脉血样检测血清超氧化物歧化酶（SOD）及丙二醛（MDA）浓度。结果两组患者各时点MAP、HR比较差异无统计学意义（P〉0．05）；Pmean在T1～T4时点明显上升，但时间与分组间无明显的交互作用（F=0．990，P=0．434）；Qs／Qt比值及氧合指数（PaO2／FiO2）在各时间比较差异有统计学意义（P〈0．01），且交互作用明显，提示帕瑞昔布钠处理后肺内分流明显减少；血清SOD、MDA浓度在各时间比较差异有统计学意义（P〈0．01），且交互作用明显，提示帕瑞昔布钠处理后明显降低机体氧化应激水平。结论帕瑞昔布钠能有效减少OLV患者的肺内分流并降低氧化应激水平。
Objective To investigate the effect of parecoxib on intrapulmonary shunt and oxidative stress following one -lung ventilation. Methods Thirty ASA I or 11 patients, aged 42 - 77 y, weighing 41 -74 kg, undergoing esophageal cancer resection, were randomly divided into 2 groups： parecoxib group （group P） intravenously received 40 mg/10 mL parecoxib and control group （group C） received 10 mL saline instead of parecoxib. Anesthesia was induced with TCI of propofol （target effect site concentration 4 μg/mL） and sufentanil （target effect site concentration 0.3 ng/mL）. Tracheal intubation was facilitated with rocuronium 0.9 mg/kg after the patients lost The patients were mechanically ventilated. Mean airway pressure （MAP）, HR and mean inspiratory pressure （Pmean） were monitored and recorded after the induction of anesthesia （T0 ）, at 15 min, 30 min, 1 h and 2 h after OLV （T1 ,T2, T3, T4 ） and 30 min and 1 h after re - expansion of the collapsed lung （Ts, T6 ）. Jugular vein and radial artery blood samples were taken simultaneously for blood gas analysis and intrapulmonary shunt rate （Qs/Qt） calculation. Artery blood samples were taken simultaneously for serum SOD and MDA contents measurement. Results There was no significant differences between the groups in MAP and HR. Pmean raised at Tl, T2, T3 and T4 time point, however, there was no significant interaction effect between time and group. Qs/Qt and oxygenation index were significantly different among the time points they measured and there were also significant difference in interaction effect between time and group which mean a significant decrease in intrapulmonary shunt and improvement in oxygenation after treated with parecoxib. Serum contents of SOD and MDA were significant different among their measured time points and there were significant interaction effect between time and group which indicate a significant decrease in oxidative stress after parecoxib treating compared with control group. Conclusion Parecoxib signific
出处
《中国急救医学》
CAS
CSCD
北大核心
2013年第12期1095-1099,共5页
Chinese Journal of Critical Care Medicine
基金
基金项目：2010年贝朗麻醉科研基金资助项目（BBF-2010-014）
关键词
环氧化酶-2抑制剂
氧化应激
肺内分流
Cyclooxygenase 2 inhibitors
Oxidative stress
Intrapulmonary shunt rate
