依达拉奉复合氯胺酮预处理对肺癌单肺通气患者围术期炎性细胞因子平衡的影响

目的观察依达拉奉复合氯胺酮预处理对肺癌单肺通气患者围术期炎性细胞因子平衡的影响。方法将择期拟行肺叶切除术肺癌患者48例随机分为对照组、依达拉奉组、氯胺酮组、联合组各12例。四组均先行麻醉诱导,依达拉奉组于诱导后予依达拉奉0.5 mg/kg,氯胺酮组于诱导前予氯胺酮0.5 mg/kg,联合组于诱导前予氯胺酮,诱导后予依达拉奉,剂量同前两组,对照组诱导前后予等量生理盐水。单肺通气时双腔管非通气侧开放,与大气相通,呼吸参数不变。于切皮前即刻、膨肺后60 min、术后60 min取四组血样测定TNF-α、IL-6和IL-10水平。结果依达拉奉组、氯胺酮组、联合组TNF-α、IL-6水平均明显低于对照组,IL-10水平明显高于对照组;依达拉奉组IL-10水平明显高于氯胺酮组;联合组TNF-α、IL-6水平均明显低于依达拉奉组及氯胺酮组,IL-10水平明显高于依达拉奉组;P均<0.05。联合组TNF-α/IL-10、IL-6/IL-10值均明显低于其他三组。结论依达拉奉复合氯胺酮预处理能更有效地抑制促炎性细胞因子生成、维持围术期促炎性细胞因子和抗炎性细胞因子相对平衡,有利于患者预后恢复。     

依达拉奉对单肺通气患者血浆SP-D、TNF-α和IL-8的影响

目的 观察依达拉奉对术中单肺通气患者血浆中肺表面活性物质相关蛋白D（SP-D）、TNF-α及IL-8水平的影响,探讨依达拉奉的肺保护作用.方法 选择ASA Ⅰ～Ⅱ级需行单肺通气肺叶切除的肺癌患者30例,随机分成依达拉奉组（Y组）和对照组（C组）各15例.患者均行双腔支气管插管并行机械通气;麻醉诱导后,Y组给予依达拉奉0.5 mg/kg加入生理盐水100 mL中,30 min内静滴;C组给予等量生理盐水静滴.两组分别在麻醉诱导后切皮前（T0）、单肺通气60min（T1）、术后2 h（T2）抽取静脉血4 mL,测定SP-D、TNF-α、IL-8及丙二醛（MDA）、超氧化物歧化酶（SOD）水平.结果 两组T1、T2的SP-D、TNF-α、IL-8水平明显高于To（P均＜0.05）,Y组T2的SP-D、TNF-α、IL-8水平明显低于C组（P均＜0.05）;T1、T2时Y组SOD明显高于C组（P均＜0.05）,MDA明显低于C组（P均＜0.05）.结论 依达拉奉能够有效减轻开胸手术单肺通气患者的炎症反应,具有肺保护作用.     

依达拉奉对慢性阻塞性肺疾病模型大鼠的干预作用

目的探讨依达拉奉在慢性阻塞性肺疾病(慢阻肺)的干预作用。方法取72只健康SD大鼠随机分为空白组、慢阻肺模型组、低剂量依达拉奉组和高剂量依达拉奉组,每组各18只,四组大鼠于造模4周后对肺功能、血清抗氧化因子、支气管肺泡灌洗液中炎性因子以及肺组织中金属蛋白酶水平进行检测和比较分析。结果肺功能检测结果显示,慢阻肺模型组与空白组相比,f、RI明显增高,Cdyn以及PIF水平均明显降低(P0.05)。与慢阻肺模型组相比,低剂量依达拉奉组RI明显降低,Cdyn、PIF水平明显升高,高剂量依达拉奉组f、RI均明显降低,Cdyn及PIF明显升高。与低剂量依达拉奉组相比,高剂量依达拉奉组Cdyn明显升高(P0.05)。血浆抗氧化物检测结果显示,与空白组相比,慢阻肺模型组MDA、SOD水平明显升高(P0.05);与慢阻肺模型组相比,低剂量依达拉奉组和高剂量依达拉奉组MDA明显降低(P0.05)。支气管肺泡灌洗液检测及结果显示,与空白组相比,慢阻肺模型组WBC、TNF-α水平明显升高(P0.05);与慢阻肺模型组相比,低剂量依达拉奉组和高剂量依达拉奉组WBC、TNF-α水平均明显降低(P0.05);与低剂量依达拉奉组相比,高剂量依达拉奉组WBC、TNF-α水平明显降低(P0.05)。肺组织检测结果显示,与空白组相比,慢阻肺模型组MMP-9、MMP-12、Caspase-12、CHOP表达明显增强(P0.05);与慢阻肺模型组相比,低剂量依达拉奉组和高剂量依达拉奉组MMP-9、MMP-12、Caspase-12、CHOP表达均明显减弱(P0.05);与低剂量依达拉奉组相比,高剂量依达拉奉组MMP-9、MMP-12、Caspase-12、CHOP表达明显减弱(P0.05)。结论依达拉奉可提高抗氧化能力、减少炎症因子的释放和聚集以及改善蛋白酶调节,对延缓慢阻肺临床病理进展有一定的作用。     

依达拉奉对肺叶切除术肺癌患者围术期炎性细胞因子和自由基的影响

目的探讨依达拉奉对肺叶切除术肺癌患者的效果及意义。方法将24例行肺叶切除术的肺癌患者随机分为观察组和对照组各12例。两组均静脉注射咪唑安定0．03mg／kg、芬太尼3μg／kg,吸入8％七氟醚。麻醉诱导后,观察组加依达拉奉0．5mg／kg;对照组予等量生理盐水。麻醉维持相同。两组均于麻醉后切皮前（T1）、单肺通气60min（T2）、膨肺后60min（T3）、术后1h（T4）、24h（T5）测定血清中TNF-α、IL-6、IL-8、超氧化物歧化酶（SOD）活性及丙二醛（MDA）浓度。结果两组TNF-α、IL-6、IL-8和MDA于他均明显升高（P〈0．05）,至T4时达峰值（P〈0．05）;与对照组比较,观察组血浆TNF-α和MDA浓度于12～4均明显降低（P〈0．05）,IL-6、IL-8浓度于耶明显降低,持续至T4（P〈0．05）。SOD活性在单肺通气后各时点无明显变化;对照组SOD活性在T2-4较明显低于基础值及观察组（P均〈0．05）。结论依达拉奉可减少氧自由基产生,抑制肺叶切除术的肺癌患者围术期全身性炎症反应,有利于改善患者预后。     

依达拉奉在心脏不停跳手术中的肺保护作用

目的探讨依达拉奉在心脏不停跳手术中对肺功能的保护作用。方法将60例需行二尖瓣置换术的风湿性心脏病患者随机分成实验组、对照组各30例。实验组于预充液中按0.5 mg/kg加入依达拉奉,对照组加入等量生理盐水。分别于术前、转机30 min、停机、术毕、术后24 h、术后72 h各时点检测血浆IL-6、IL-8含量,并于术前、停机、停机后1 h、术毕记录气道峰压、潮气量,并行动脉血气分析,计算动态肺顺应性、肺泡—动脉血氧分压差、氧合指数。结果两组IL-6、IL-8浓度水平均随体外循环及手术时间逐渐增高,于手术结束时达高峰,术后24 h下降,实验组IL-6、IL-8低于对照组（P〈0.01）。两组气道峰压、肺泡—动脉血氧分压差自手术开始后升高,动态肺顺应性、氧合指数自手术开始后下降,依达拉奉组结果优于对照组（P〈0.01）。结论依达拉奉可清除体内过量生成的氧自由基及减少炎性因子的生成,减轻全身炎性反应及肺组织损伤,具有减轻体外循环急性肺损伤的作用。     

依达拉奉对实验性高脂血症小鼠的影响

目的观察依达拉奉对高脂血症小鼠血脂的调节作用。方法18-22g雄性昆明小鼠随机分为空白对照组、高脂血症模型对照组、依达拉奉3mg／kg和6mg／kg组及辛伐他汀组。给药10d后眼眶取血，测定血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）含量，计算动脉粥样硬化指数（AI）及肝脏系数。结果与模型对照组比较，依达拉奉3mg／kg和6mg／kg组中血清HDL-C含量升高44．2％和81．4％（P均〈0．05）；AI降低33．8％和50．0％（P均〈0．05）；肝脏系数下降12.3％和13．8％（P均〈0．05）。结论依达拉奉具有调节血脂的作用。     

依达拉奉对大鼠急性坏死性胰腺炎的保护作用

目的:探讨自由基清除剂依达拉奉对大鼠急性坏死性胰腺炎的保护作用及其机制.方法:90只♂SD大鼠随机分为假手术组(SHAM组)、坏死性胰腺炎组(ANP组)、依达拉奉治疗组(EDA组),每组30只.SHAM组为开腹后只翻动十二指肠及胰腺后关腹;ANP组胰胆管内逆行输注1.5%脱氧胆酸钠制备急性坏死性胰腺炎模型;EDA组为ANP造模后立即尾静脉注射依达拉奉(6mg/kg).分别于术后6、12、24h处死大鼠(每个时点10只),观察胰腺病理形态改变并评分;检测血清淀粉酶、TNF-α、ET-1、sICAM-1含量;检测胰腺组织中丙二醛(MDA)含量及总超氧化物歧化酶(T-SOD)活力.结果:与ANP组比较,EDA治疗组在胰腺病理改变、血清TNF-α水平(6h:109.6ng/L±49.0ng/Lvs190.2ng/L±46.6ng/L,12h:405.4ng/L±116.3ng/Lvs559.7ng/L±203.9ng/L,24h:415.4ng/L±164.6ng/Lvs648.7ng/L±222.1ng/L,均P<0.05)、血清ET-1水平(6h:45.6ng/L±13.5ng/Lvs66.0ng/L±16.0ng/L,12h:83.5ng/L±15.4ng/Lvs96.8ng/L±23.0ng/L,24h:85.1ng/L±25.8ng/Lvs103.9ng/L±28.9ng/L),血清sICAM-1水平(6h:0.58ng/L±0.13ng/Lvs0.78ng/L±0.14ng/L,12h:0.78ng/L±0.10ng/Lvs0.94ng/L±0.12ng/L,24h:0.96ng/L±0.16ng/Lvs1.24ng/L±0.30ng/L,均P<0.05)、胰腺组织MDA含量(6h:4.22nmol/mgprot±0.40nmol/mgprotvs8.79nmol/mgprot±0.80nmol/mgprot,12h:5.90nmol/mgprot±0.51nmol/mgprotvs12.30nmol/mgprot±1.02nmol/mgprot,24h:9.10nmol/mgprot±0.84nmol/mgprotvs17.88nmol/mgprot±1.43nmol/mgprot)均有不同程度减轻(均P<0.05),T-SOD活力增强(6h:88.6U/mgprot±7.1U/mgprotvs68.8U/mgprot±10.5U/mgprot,12h:77.6U/mgprot±6.8U/mgprotvs46.0U/mgprot±8.9U/mgprot,24h:45.5U/mgprot±5.3U/mgprotvs27.8U/mgprot±4.3U/mgprot,均P<0.05);血清淀粉酶变化无显著差异.与SHAM组比较,ANP组胰腺组织病理评分、血清淀粉酶、TNF-α、ET-1、sICAM-1明显升高,胰腺组织MDA含量升高,T-SOD活力下降,差异均有统计学意义.结论:依达拉奉可以清除坏死性胰腺炎体内过量生成的氧自由基并减少炎性因子的表达,减轻胰腺组织损伤.     

依达拉奉对急性脑出血的抗氧化作用

82例急性脑出血患者随机分为常规治疗组和依达拉奉组,依达拉奉组在常规治疗基础上给予依达拉奉治疗10 d。与治疗前比较,两组患者治疗后血清一氧化氮、过氧化脂质水平明显降低,谷胱甘肽过氧化物酶及超氧化物歧化酶水平明显升高,依达拉奉组优于常规治疗组。提示急性脑出血患者早期应用依达拉奉治疗可以减轻或防止继发性脑损伤,促进细胞功能的恢复。     

依达拉奉在急性缺血性脑卒中治疗中的作用

在世界范围内,脑卒中是继心血管病和癌症之后的第三大常见死亡原因.随着人们对急性脑卒中氧化应激损害的深入研究,抗氧化治疗在急性缺血性脑卒中治疗中的重要性越来越得到人们的关注.2009年8月-2009年11月我们在60例急性缺血性脑卒中患者的治疗中加用自由基清除剂依达拉奉(易达生)抗氧化治疗取得满意效果,现报道如下.     

自由基清除剂依达拉奉对脑缺血的治疗作用

自由基在各种缺血性损伤中起重要作用。自由基清除剂依达拉奉打破了神经保护治疗无效的悲观现状。动物实验和临床试验表明 ,依达拉奉在治疗缺血再灌注损伤中的有效。     

Adult patient with pulmonary agenesis: focusing on one-lung ventilation during general anesthesia

Congenital pulmonary agenesis is a rare condition with high mortality. Mechanical ventilation in these patients is challenging and there has no such case been reported in the literature. We reported a 61-year-old female with lung agenesis who presented to our hospital with pneumonia and pelvic mass. In the past, she had undergone repairing of atrial septal defect and mitral valve forming surgery at 6-year-old. Thereafter she had remained asymptomatic until this time of hospital admission. The patient underwent operation for the pelvic mass with one-lung ventilation (OLV) under general anesthesia. We highlighted the use of protective ventilation (PV) strategy during OLV.     

Individualized positive end-expiratory pressure (PEEP) during one-lung ventilation for prevention of postoperative pulmonary complications in patients undergoing thoracic surgery: A meta-analysis

Background:Positive end-expiratory pressure (PEEP) is an important part of the lung protection strategies for one-lung ventilation (OLV). However, a fixed PEEP value is not suitable for all patients. Our objective was to determine the prevention of individualized PEEP on postoperative complications in patients undergoing one-lung ventilation.Method:We searched the PubMed, Embase, and Cochrane and performed a meta-analysis to compare the effect of individual PEEP vs fixed PEEP during single lung ventilation on postoperative pulmonary complications. Our primary outcome was the occurrence of postoperative pulmonary complications during follow-up. Secondary outcomes included the partial pressure of arterial oxygen and oxygenation index during one-lung ventilation.Result:Eight studies examining 849 patients were included in this review. The rate of postoperative pulmonary complications was reduced in the individualized PEEP group with a risk ratio of 0.52 (95% CI:0.37–0.73; P = .0001). The partial pressure of arterial oxygen during the OLV in the individualized PEEP group was higher with a mean difference 34.20 mm Hg (95% CI: 8.92–59.48; P = .0004). Similarly, the individualized PEEP group had a higher oxygenation index, MD: 49.07mmHg, (95% CI: 27.21–70.92; P < .0001).Conclusions:Individualized PEEP setting during one-lung ventilation in patients undergoing thoracic surgery was associated with fewer postoperative pulmonary complications and better perioperative oxygenation.     

瑞芬太尼复合丙泊酚单肺通气麻醉的临床价值分析

目的探讨瑞芬太尼复合丙泊酚单肺通气麻醉的临床价值。方法 84例患者随机分成两组:实验组42例,瑞芬太尼复合丙泊酚全凭静脉麻醉;对照组42例,瑞芬太尼与异氟烷静吸复合麻醉。观察两组的血流动力学、血气分析及应激激素水平。结果实验组切皮前5min SBP、DBP、HR及术毕前10 minHR明显低于对照组(P<0.05);实验组切皮后30 min SpO2及切皮前5min、切皮后5 min、术毕前10 min PaO2明显高于对照组(P<0.05);实验组切皮后30 min、术毕前10 min Cor、AⅡ及切皮前5 min、切皮后5 min、术毕前10 min的IL-6明显低于对照组(P<0.05)。结论瑞芬太尼复合丙泊酚单肺通气麻醉的效果良好。     

压力和容量控制通气在老年单肺麻醉肺保护通气策略中的比较

目的比较老年开胸手术单肺通气中压力控制通气（PCV）和容量控制通气（VCV）模式对呼吸力学和动脉血气的影响。方法46例术前肺功能不正常行开胸手术的患者,年龄均＆gt;60岁,双肺通气（TLV）期间均采用VCV模式（TLV-VCV）,单肺通气（OLV）后先采用传统方法通气（OLV-VCV1）,25 min后改为单肺保护通气（OLV-VCV2）,25 min后再改为压力控制通气（OLV-PCV）。监测气道峰压（Ppeak）、气道平台压（Pplat）、气道阻力（Raw）、动态胸肺顺应性（Cdyn）、分钟通气量（MV）等。结果与TLV-VCV比较,OLV-VCV1模式时Ppeak、Pplat、Raw升高（P〈0.01）、Cdyn降低（P〈0.01）。与OLV-VCV1比较,OLV-VCV2及OLV-PCV时Ppeak、Pplat、Raw较低,Cdyn较好（P均〈0.05）。OLV时动脉血PaO2较TLV时下降（P〈0.01）,OLV-PCV及OLV-VCV2时PaO2及PaCO2较OLV-VCV1升高（P〈0.05）。结论PCV模式控制气道压更有利于减少气道损伤,更适用于肺功能不全行开胸手术的老年患者。     

Accuracy of noninvasive continuous arterial pressure monitoring using ClearSight during one-lung ventilation

Noninvasive continuous arterial pressure monitoring may be clinically useful in patients who require continuous blood pressure monitoring in situations where arterial catheter placement is limited. Many previous studies on the accuracy of the noninvasive continuous blood pressure monitoring method reported various results. However, there is no research on the effectiveness of noninvasive arterial pressure monitoring during one-lung ventilation. The purpose of this study was to compare arterial blood pressure obtained through invasive method and noninvasive method by using ClearSight during one-lung ventilation.In this retrospective observational study, a total of 26 patients undergoing one-lung ventilation for thoracic surgery at a single institution between March and July 2019 were recruited. All patients in this study were cannulated on their radial artery to measure continuously invasive blood pressures and applied ClearSight on the ipsilateral side of the cannulated arm. We compared and analyzed the agreement and trendability of blood pressure recorded with invasive and noninvasive methods during one-lung ventilation.Blood pressure and pulse rate showed a narrower limit of agreement with a percentage error value of around 30%. In addition, the tracking ability of each measurement could be determined by the concordance rate, all of which were below acceptable limits (92%).In noninvasive arterial blood pressure monitoring using ClearSight, mean blood pressure and pulse rate show acceptable agreement with the invasive method.     

Case reports of one-lung ventilation using Fuji Uniblocker bronchial blockers for infants under one-year-old in uniportal video-assisted thoracoscopic surgery

Introduction:Uniportal video-assisted thoracoscopic surgery (VATS) for various pulmonary diseases provides advantages of less postoperative pain and earlier post-operative recovery over traditional open surgery. The inherent limitation of this surgical modality in manipulation of surgical instruments renders intra-operative one-lung ventilation a requisite to increase the substantially restricted working space and thus visibility of the surgical filed.Patient concerns:Patient 1, an 8-month-old, 9-kg, and 70 cm-in-height male infant was diagnosed as congenital pulmonary airway malformation (CPAM) over left lower lobe.Patient 2, a 9-month-old, 8-kg and 72 cm-in-height male infant was diagnosed as CPAM over right lower lobe.Patient 3, an 8-month-old, 8-kg and 67 cm-in-height female infant was diagnosed as CPAM over left lower lobe.This facilitating one-lung ventilation yet was rarely conducted in infants under one year of age for the extremely small body size, the unavailability of dedicated tools, and therein the very tough techniques demanded.Diagnosis:Infants with congenital cystic adenomatoid malformationInterventions:Here we report three infants of less than one year of age in whom one-lung ventilation was successfully achieved by intraluminal use of 5-Fr Fuji Uniblocker Bronchial Blocker devices and in turn assisted the completion of uniportal VATS for congenital cystic adenomatoid malformation in unilateral lungs.Outcomes:Three infants received VATS under uniblocker smoothly. Patient 1 had two episode of balloon dislodgement and desaturation and solved by re-insertion. And he had subglottic tracheal stenosis which treatment with laser coagulation. Patient 2 had overall blood loss 80 ml. Patient 3 had one episode of desaturation after stapling the bronchus and fiberoptic bronchoscope revealed obstruction by blood and secretion which solved by suction.Conclusion:In conclusion, OLV in infants undergoing uniportal VATs could be successfully achieved by Fuji 5 Fr Uniblocker bronchial blockers for as long as 4 hours, as exemplified by our three cases, and balloon poor sealing and dislodgment can be immediately solved by bronchoscope-guided re-positioning without compromising surgical proceeding or outcome.     

双侧肺同期手术中不同体位和单肺通气对病人呼吸力学的影响

目的观察双侧肺同期手术中体位改变和单肺通气时对病人呼吸力学的影响。方法选取我院2007年6月至2010年12月双侧肺同期手术病人142例,经气道旁路采用旁气流通气连续监测病人PIP、Pplat、Raw、Cdyn等呼吸力学指标,监测SpO2、PETCO2指标,分别在双腔支气管导管定位后,平卧改侧卧,单肺通气及改换通气方式后10 min抽取动脉血进行血气分析。结果病人双肺通气改变体位和单肺通气后,病人PIP、Pplat、Raw升高,Cdyn减少,PH值降低,PETCO2、PaCO2升高、SpO2、PaO2降低(P<0.05);双肺通气改换通气方式后,病人PIP、Pplat、Raw降低,Cdyn增加,PH值降低,PaO2、SpO2、PaCO2、PETCO2升高(P<0.05)。单肺通气38例病人改换通气方式后,病人PIP、Pplat、Raw降低,Cdyn增加,PH值、PaO2、SpO2升高,PaCO2、PETCO2降低(P<0.05)。结论双侧肺同期手术麻醉中不同体位和单肺通气对病人的呼吸力学影响较大,改换通气方式可改变病人呼吸力学指标。     

静吸复合依达拉奉麻醉下老年患者术后认知功能变化与围术期脑氧饱和度数值的关系

目的 探讨围术期脑氧饱和度（rSO2）与静吸复合依达拉奉麻醉下老年患者术后认知功能变化的关系,为临床麻醉提供指导。方法 选取2013年1月到2014年1月期间在解放军总医院入院择期行腹部及下肢手术的60例美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级、年龄＞60岁的患者。随机分为3组：依达拉奉1组（E1组：30mg依达拉奉溶于100ml 0.9% NaCl）、依达拉奉2组（E2组：60mg依达拉奉溶于100ml 0.9% NaCl）和空白对照组（C组：100ml 0.9% NaCl）,每组20例,麻醉后手术中30min静脉点滴完成。麻醉前均不用术前药,入室后给予阿托品0.5mg,缓慢静注丙泊酚、芬太尼、顺阿曲库铵快速诱导气管插管,机械通气,维持呼气末二氧化碳分压（Pet CO2）在正常范围,监测术中的rSO2变化。应用简易智力状态检查（MMSE）、连线测试及凹槽拼板测试来评定3组患者术前24h,术后4,8,12,24h的认知功能变化。结果 （1）3组患者的一般情况比较差异无统计学意义（P＞0.05）;（2）3组患者术前MMSE、连线测试及凹槽拼板测试评分差异无统计学意义（P＞0.05）;（3）E2组和E1组患者术后认知测试评分均明显高于C组（P＜0.05）,术中3组患者的rSO2数值水平差异无统计学意义（P＞0.05）。结论 依达拉奉在静吸复合麻醉中的应用,能降低老年患者术后认知功能障碍的发生率,可能与其独特的神经保护,消除氧自由基、抑制脂质过氧化反应和调控凋亡相关基因表达有关,提高中枢对于缺血低氧的耐受力有关。     

机械通气对肺部及全身炎症介质水平的影响

呼吸机相关肺损伤是指不当的机械通气可导致或加重肺损伤,它是由多种因素综合作用的结果.肺生物伤作为呼吸机相关肺损伤的类型之一,表现为不当的机械通气方式会导致肺组织产生并释放大量炎症介质,并且这些炎症介质会随血液循环进入远隔器官,与急性呼吸窘迫综合征患者多器官功能衰竭及病死率密切相关.