本文關(guān)鍵詞：磷酸肌酸鈉預(yù)處理對(duì)單肺通氣后缺血再灌注損傷的保護(hù)作用　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:行電視胸腔鏡手術(shù)的患者的麻醉常需采用單肺通氣模式進(jìn)行呼吸管理,術(shù)后的急性肺損傷是胸外科術(shù)后嚴(yán)重的并發(fā)癥之一,單肺通氣引起的肺缺血再灌注損傷被認(rèn)為是其發(fā)病機(jī)制中的重要因素。近年來(lái),研究發(fā)現(xiàn)磷酸肌酸鈉能夠減輕一些重要器官的缺血再灌注損傷,具有保護(hù)作用。但對(duì)單肺通氣后肺的缺血再灌注損傷是否具有保護(hù)作用尚未見(jiàn)報(bào)道。本研究擬觀察磷酸肌酸鈉預(yù)處理對(duì)行胸腔鏡手術(shù)患者單肺通氣后缺血再灌注損傷的肺保護(hù)作用,并探討其作用機(jī)制。方法:選擇擇期于全麻下單肺通氣行胸腔鏡下肺葉切除患者40例為研究對(duì)象,年齡:18歲至65歲,ASA分級(jí):Ⅰ至Ⅱ,預(yù)計(jì)術(shù)中單肺通氣時(shí)長(zhǎng)在60和＜120min之間。ASA分級(jí):Ⅲ至Ⅳ級(jí),呼吸功能嚴(yán)重障礙,凝血障礙或血小板減少,接受過(guò)化療或放射治療或免疫治療,全身或局部感染,3個(gè)月內(nèi)服用過(guò)維生素或非甾體類抗炎藥或糖皮質(zhì)激素的患者需排除在外。所有患者采用數(shù)字表法隨機(jī)分為對(duì)照組和實(shí)驗(yàn)組。對(duì)照組患者(20例):術(shù)前30分鐘,1OOml0.9%生理鹽水靜脈滴注,輸注時(shí)間30分鐘。實(shí)驗(yàn)組患者(20例):術(shù)前30分鐘,磷酸肌酸鈉30mg/kg加入100ml0.9%生理鹽水中靜脈滴注,輸注時(shí)間30min。所有患者遵醫(yī)囑常規(guī)術(shù)前準(zhǔn)備,入手術(shù)室半小時(shí)前于病房肌注苯巴比妥鈉0.1g,阿托品0.5mg。入手術(shù)室后面罩低流量吸氧,建立動(dòng)、靜脈通路。監(jiān)測(cè)心率、血氧飽和度、有創(chuàng)動(dòng)脈血液壓、腦電雙頻譜指數(shù)(BIS)等基本生命體征。予患者咪達(dá)唑侖0.1mg/kg,舒芬太尼0.5-1ug/kg,順式阿曲庫(kù)銨0.15-0.2mg/kg,依托咪酯0.3mg/kg行麻醉誘導(dǎo),可視喉鏡行雙腔氣管插管,纖支鏡定位,手術(shù)開(kāi)始后行非手術(shù)側(cè)單肺通氣,術(shù)中采用全憑靜脈維持麻醉深度,持續(xù)泵注丙泊酚、瑞芬太尼、順式阿曲庫(kù)銨,并根據(jù)BIS值調(diào)節(jié),間斷追加舒芬太尼,以維持BIS值40-60.患者血流動(dòng)力學(xué)指標(biāo)波動(dòng)范圍不超過(guò)入室時(shí)的20%。分別于單肺通氣即刻(T0)、單肺通氣后1h(T1)、雙肺通氣后1h(T2)、雙肺通氣后2h(T3)通過(guò)橈動(dòng)脈采集3.5ml動(dòng)脈血,置于5ml促凝試管中,樣本在室溫下自然凝固后離心,收集上清液。將標(biāo)本置于-80℃低溫冰箱中凍存,待所有血清樣本全部收集完畢再一同檢測(cè)。采用酶聯(lián)免疫分析法檢測(cè)各時(shí)間點(diǎn)IL-6、TNF-α,比色法檢測(cè)MP0、硫代巴比妥鈉法檢測(cè)MDA。結(jié)果:兩組單肺通氣患者血清炎癥因子TNF-α、IL-6和氧化應(yīng)激指標(biāo)MPO、MDA隨著時(shí)間有不同程度的升高,但經(jīng)過(guò)磷酸肌酸鈉預(yù)處理的實(shí)驗(yàn)組血清IL-6水平、MDA水平、MP0活力在T1、T2、T3時(shí)間點(diǎn)和血清TNF-α水平在T2、T3時(shí)間點(diǎn)較對(duì)照組的明顯減低(P＜0.05)。結(jié)論:1、單肺通氣過(guò)程中有炎癥因子TNF-α、IL-6和氧化應(yīng)激指標(biāo)MPO、MDA不同程度的升高,提示單肺通氣過(guò)程可引起肺組織損傷。2、磷酸肌酸鈉預(yù)處理可減輕炎癥因子TNF-α、IL-6和氧化應(yīng)激指標(biāo)MPO、MDA的升高,對(duì)單肺通氣后肺損傷具有保護(hù)作用,其機(jī)制可能與減輕單肺通氣后缺血再灌注引起的炎癥反應(yīng)和氧化應(yīng)激有關(guān)。
[Abstract]:Objective: the patients undergoing video-assisted thoracoscopic surgery often need to use one-lung ventilation mode for respiratory management. Postoperative acute lung injury is one of the serious complications after thoracic surgery. Pulmonary ischemia-reperfusion injury induced by one-lung ventilation is considered to be an important factor in its pathogenesis. In recent years, it has been found that creatine phosphate can alleviate the ischemia-reperfusion injury in some important organs. The protective effect of creatine phosphate sodium preconditioning on ischemia-reperfusion injury after single lung ventilation in patients undergoing thoracoscopic ventilation has not been reported. This study is intended to observe the effect of creatine phosphate preconditioning on ischemia / reperfusion injury after single lung ventilation in patients undergoing thoracoscopic ventilation. Injured lung protection. Methods: 40 patients with pulmonary lobectomy under thoracoscopy were selected as subjects, aged from 1 to 18 years old to 65 years old, with ASA grade: 鈪，

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