不同吸入氧浓度对肺癌根治术患者单肺通气后氧合及氧化应激的影响

Effects of different inspired oxygen on oxygenation and oxidative stress after one-lung ventilation in lung cancer radical surgery patients

摘要:

目的  探讨不同吸入氧浓度对肺癌根治术患者单肺通气（OLV）后氧合和氧化应激的影响。方法  选择60例开胸单叶肺切除术的肺癌患者，随机分为A、B两组（每组30例），OLV后吸入氧浓度（FiO2）A组为100%，B组为50%。分别于侧卧位单肺通气前（T0）、OLV 30 min（T1）、OLV结束前（T2）、关胸后（T3）及术后2 h（T4）抽取桡动脉血和右心房血行血气分析，计算氧合指数（PaO2/FiO2）、呼吸指数（RI）和肺内分流率（Qs/Qt）。同时抽桡动脉血测定氧化应激指标超氧化物歧化酶（SOD）和丙二醛（MDA）。结果  两组各时间PaO2/FiO2比较，差异无统计学意义（P >0.05）。T1~T4时B组RI低于A组（P <0.05），Qs/Qt也低于A组（P <0.05）。T4时B组MDA值低于A组（P <0.05），SOD值高于A组（P <0.05）。结论  OLV后50%吸入氧浓度可降低Qs/Qt和氧化应激反应，改善氧合。

Abstract:

Objective To investigate the effects of different inspired oxygen fraction (FiO2) on oxygenation and oxidative stress after one-lung ventilation (OLV) in lung cancer radical surgery patients. Methods Sixty patients of lung cancer scheduled for pulmonary lobectomy were randomly divided into two groups with 30 cases in each group. Different FiO2 were given after starting OLV: FiO2 in the group A was 100%, FiO2 in the group B was 50%. The radial artery and right atrial blood of all the patients were taken to measure oxygenation index (PaO2/FiO2), respiratory index (RI) and intrapulmonary shunt fraction (Qs/Qt) before starting OLV in the lateral position (T0), 30 min after one-lung ventilation (T1), before the end of one-lung ventilation (T2), after closure of thoracic cavity (T3) and 2 hours after operation (T4). The radial artery blood was also used to measure plasma superoxide dismutase (SOD) and malondialdehyde (MDA). Results From T1 to T4, RI of the group B was lower than that of the group A (P < 0.05), Qs/Qt of the group B was also lower than that of the group A (P < 0.05).  At T4, MDA in the group B was lower than that in the group A, while SOD was higher than that in the group A (P < 0.05). Conclusions After starting one-lung ventilation, 50% FiO2 can reduce Qs/Qt and oxidative stress, and improve oxygenation function.