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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2020年05期

页码:

653-658

栏目:

论著

出版日期:

2020-10-20

文章信息/Info

Title:

Effects of doxofylline on intraoperative pulmonary protection and its mechanism in patients undergoing double lumen endotracheal intubation for one-lung ventilation

作者:

彭 品¹; 陆 俊²; 方 瑜²; 房明浩²

430000 武汉,武汉亚心总医院重症医学科¹ 430000 武汉,华中科技大学同济医学院附属同济医院重症医学科²

Author(s):

Peng Pin¹;  Lu Jun²;  Fang Yu²;  Fang Minghao².

¹Department of Critical Medicine, Wuhan Yaxin General Hospital, Wuhan City 430000, Hubei Province, China; ²Department of Critical Medicine, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology, Wuhan City 430000, Hubei Province, China

关键词:

多索茶碱;  手术;  气管插管;  单肺通气;  肺保护效应

Keywords:

Doxofylline;  Operation;  Tracheal intubation;  One-lung ventilation;  Pulmonary protection

分类号:

R974.3

DOI:

10.3877/cma.j.issn.1674-6902.2020.05.015

摘要:

目的 探讨多索茶碱对双腔气管插管单肺通气患者术中肺保护效应及其作用机制。方法 将120例开胸肺叶切除术患者分为两组,研究组62例, 对照组58例。两组均在双腔气管插管全身麻醉下进行单肺通气,研究组术中使用多索茶碱注射液进行干预,对照组使用等量生理盐水进行干预。全部患者于侧卧位后给药前即刻(T1)、单肺通气0.5 h(T2)、单肺通气1h(T3)测定呼吸动力指标(肺顺应性、气道阻力、气道平台压和气道峰压)、血气分析指标(PaO₂、PaCO₂)、氧化应激指标(MDA、SOD)、炎症指标(TNF-α、IL-6、IL-10),比较两组术后肺部并发症发生率的差异。结果 T1时,两组呼吸动力指标、血气分析指标、氧化应激指标和炎症指标比较差异无统计学意义(P>0.05)。在T2～T3时,两组肺顺应性、PaO₂、SOD较T1明显降低,气道阻力、气道平台压、气道峰压、PaCO₂、MDA、IL-6、IL-10、TNF-α较T1明显增高,P<0.05。而在T2～T3时,研究组肺顺应性、PaO₂、SOD、IL-10较对照组明显增高,气道阻力、气道平台压、气道峰压、PaCO₂、MDA、IL-6、TNF-α较对照组明显降低,两组比较差异具有统计学意义(P<0.05)。研究组手术后肺部并发症发生率明显低于对照组,P<0.05。结论 多索茶碱通过明显改善双腔气管插管单肺通气患者的肺氧合功能,降低肺部并发症的风险,从而发挥重要的术中肺保护效应,其作用机制可能与多索茶碱抗氧化应激、抗炎、扩张支气管和改善通气具有紧密的关系。

Abstract:

Objective To investigate the effects of doxofylline on intraoperative pulmonary protection and its mechanism in patients undergoing double lumen endotracheal intubation for one-lung ventilation. Methods 120 patients given pulmonary lobotomy were divided into two groups, 62 cases in study group, 58 cases in control group. Two groups underwent general anesthesia using double lumen endotracheal intubation for one-lung ventilation, the study group were used doxofylline injection for intervention, while the control group were used equal volume of normal saline for intervention. All patients of respiratory dynamics index(compliance of lung, resistance airway, pressure of platform, pressure of peak), blood gas analysis indexes(PaO₂, PaCO₂)and oxidative stress indicators(MDA, SOD), inflammation index(TNF-α, IL-6, IL-10)were detected immediately before administration(T1), at 30 min(T2), 60 min(T3)after one-lung ventilation, the difference of postoperative pulmonary complications between the two groups were compared. Results At T1, there were no significant differences in respiratory dynamics, blood gas analysis, oxidative stress and inflammation indexes between the two groups(P>0.05), which were comparable. At T2～T3, compliance of lung, PaO₂ and SOD in the two groups were significantly lower than T1, and resistance of airway, pressure of platform, pressure of peak, PaCO₂, MDA, IL-6, IL-10 and TNF-α were significantly higher than T1, P<0.05.At T2～T3, compliance of lung, PaO₂, SOD, and IL-10 in the study group were significantly higher than those in the control group, and resistance of airway, pressure of platform, pressure of peak, PaCO₂, MDA, IL-6, and TNF-α were significantly lower than those in the control group(P<0.05). The incidence of pulmonary complications in the study group was significantly lower than that in the control group, P<0.05. Conclusion Doxofylline can significantly improve pulmonary oxygenation function, reduce the risk of pulmonary complications, thus play an important role on intraoperative pulmonary protection in patients undergoing double lumen endotracheal intubation for one-lung ventilation. The mechanism may be closely related to doxofylline's anti-oxidative stress, anti-inflammatory, bronchiectasis and ventilation improvement.

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更新日期/Last Update: 2020-10-20