Lung Protection Effect of Hypertonic Saline for One-lung Ventilation Patients_West China Medical Journal

Authors：

JIN Tao , LI Xu , YUAN Fang

Department of Anesthesiology, First People’s Hospital of Suining, Suining, Sichuan 629000, P. R. China;

Corresponding author：

Keywords：

高渗氯化钠溶液; 单肺通气; 氧合指数; 呼吸指数; 肺顺应性; 肺保护

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【摘要】　目的　通过观察单肺通气患者术中氧合指数（oxygenation index，OI）、呼吸指数（respiratory index，RI）及动态肺顺应性（dynamic lung compliance，Cdyn）的变化，探讨高渗氯化钠溶液对术中单肺通气患者的肺保护作用。　方法　选择2009年12月-2011年2月完成的美国麻醉师协会分级为Ⅰ~Ⅲ级，心肺功能筛查、血常规、肝肾功能及凝血功能无明显异常，拟在全麻双腔气管插管下行开胸手术，术中需行单肺通气患者60例，随机分为高渗氯化钠组（A组）和对照组（B组），每组30例。A组在开始单肺通气后30 min快速输注7.5%高渗氯化钠溶液2 mL/kg，15 min内输注完毕，B组输注等量生理盐水，分别记录输注前（T1）、输注完毕时（T2）、输注后30 min（T3）、输注后1 h（T4）的OI、RI及Cdyn变化，并比较两组各时间点生命体征变化。　结果　两组患者OI、RI及Cdyn在T1、T2时差异无统计学意义（P gt;0.05）；两组患者不同时间点平均动脉压、心率、脉搏血氧饱和度、中心静脉压、呼气末CO2分压比较差异无统计学意义（P gt;0.05）；A组患者在T3、T4时的OI和Cdyn较B组明显升高，RI明显降低（P lt;0.05）；且A组患者在T3、T4时的OI和Cdyn较T1时明显增高，RI明显降低（P lt;0.05）。　结论　高渗氯化钠溶液能改善术中单肺通气患者的OI、RI及Cdyn，对肺功能有一定的保护作用。
【Abstract】　Objective　 To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects.　Methods　 Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared.　Results　 OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (P gt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (P gt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (P lt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (P lt;0.05).　Conclusion　 Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.

Citation： JIN Tao,LI Xu,YUAN Fang. Lung Protection Effect of Hypertonic Saline for One-lung Ventilation Patients. West China Medical Journal, 2011, 26(8): 1192-1194. doi: Copy

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1. 　宋俊东, 郑敏. 高渗盐溶液对脑损伤的保护作用[J]. 黑龙江医学, 2006(12): 900-903.
2. 　张岩, 智绪亭, 张建民, 等. 高渗盐水对肝脏缺血再灌注损伤保护作用的临床研究[J]. 中国现代普通外科进展, 2009, 12(4): 313-316.
3. 　柯庆宏, 郑树森, 梁廷波, 等. 高渗盐水预处理可减轻中性粒细胞介导的肝脏缺血再灌注损伤[J]. 中国病理生理杂志, 2007, 23(7): 1326-1330.
4. 　刘红, 韩洪伟, 马聚峰, 等. 高渗盐水对大鼠肢体缺血再灌注致心肌损伤的保护作用[J]. 宁夏医学杂志, 2007, 29(12): 1059-1060.
5. 　蔡秀军, 牟一平. 高渗盐水治疗未控制出血的失血性休克动物实验及临床观察[J]. 中国普外基础与临床杂志, 1998, 5(1): 14-15.
6. 　Ishikawa, Seijia B, Lohser, et al. One-lung ventilation and arterial oxygenation[J]. Curr Opin Anaesthesiol, 2011, 2(24): 24-31.
7. 　Moutafis M, Liu N, Dalibon N, et al. The effects of inhaled nitric oxide and its combination with intravenous almitrine on PaO2 during one-lung ventilation in patients undergoing thoracoscopic procedures[J]. Anesth Analg, 1997, 85(5): 1130-1135.
8. 　任光国, 周允中. 胸外科手术并发症的预防和治疗[M]. 北京: 人民卫生出版社, 2004: 474.
9. 　Yada-langui MM, Anjos-valotta EA, Sannomiya P, et al. Resuscitation affects microcirculatory polymorphonuclear leukocyte behavior after hemorrhagic shock:role of hypertonic saline and pentoxifylline[J]. Exp Biol Med(Maywood), 2004, 229(7): 684-693.
10. 　周其全, 支东学. 高渗盐水对低氧条件下失血性休克时肺损伤的保护作用[J]. 中华实验外科杂志, 1994, 11(5): 299-300.
11. 　Poli-de-figueiredo LF, Cruz RJ, Sannomiya P, et al. Mechanisms of action of hypertonic saline resuscitation in severe sepsis and septic shock[J]. Endocr Metab Immune Disord Drug Targets, 2006, 6(2): 201-206.
12. 　Ghafari MH, Moosavizadeh SA, Moharari RS, et al. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock[J]. Middle East J Anesthesiol, 2008, 19(6): 1337-1347.
13. 　Lewis FR, Elings VB, Hill SL, et al. The measurement of extravascular lung water by thermal-green dye indicator dilution[J]. Ann N Y Acad Sci, 1982, 384: 394-410.

West China Medical Journal

Lung Protection Effect of Hypertonic Saline for One-lung Ventilation Patients

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