氟比洛芬酯对胸腔镜右肺叶切除术患者单肺通气期间肺功能的影响

Effect of flurbiprofen axetil on lung function in patients undergoing thoracoscopic right lung lobectomy during one-lung ventilation

中文关键词: 胸腔镜  肺叶切除术  封堵器  单肺通气  氟比洛芬酯  氧合  呼吸力学

英文关键词: Thoracoscopy  Lung lobectomy  Endobronchial blocker  One-lung ventilation  Flurbiprofen axetil  Oxygenation  Respiratory mechanics

中文摘要:

      
目的： 观察氟比洛芬酯对胸腔镜右肺叶切除术患者采用封堵器行单肺通气期间肺氧合功能、呼吸力学及肺部并发症的影响。
方法： 选择择期全麻下行胸腔镜右肺叶切除术采用封堵器行单肺通气的患者60例，男25例，女35例，年龄35～64岁，BMI 18～28 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：氟比洛芬酯组（F组）和对照组（C组），每组30例。F组在麻醉诱导前15 min静注氟比洛芬酯1.0 mg/kg，C组不予处理。于麻醉诱导前20 min（T₀）、单肺通气30 min（T₁）、单肺通气60 min（T₂）、双肺通气15 min（T₃）时抽取桡动脉血行血气分析，计算氧合指数（OI）并记录SpO₂。记录T₁、T₂时的气道峰压（Ppeak）、气道平台压（Pplat）、肺动态顺应性（Cdyn）和无效腔气量与潮气量之比（V_D/V_T）。记录单肺通气期间低氧血症发生情况、补救例数、术后转ICU例数、术后72 h内肺不张、急性肺损伤和肺炎发生情况。
结果： 与C组比较，F组T₁时SpO₂、T₁—T₃时PaO₂和OI、T₁、T₂时Cdyn明显升高（P<0.05）；T₁、T₂时Ppeak和V_D/V_T、T₂时Pplat明显降低（P<0.05）。两组无一例单肺通气期间发生低氧血症和补救、术后转入ICU、术后72 h内发生肺不张、急性肺损伤和肺炎。
结论： 对胸腔镜右肺叶切除术采用封堵器行单肺通气的患者，麻醉诱导前静注氟比洛芬酯有助于改善单肺通气期间肺氧合功能，优化呼吸力学参数。

英文摘要:

      
Objective: To observe the effect of flurbiprofen axetil on lung oxygenation function, respiratory mechanics and pulmonary complications in patients undergoing thoracoscopic right lung lobectomy with endobronchial blockers during one-lung ventilation (OLV).
Methods: Sixty patients scheduled for elective thoracoscopic right lung lobectomy with endobronchial blockers for OLV, 25 males and 35 females, aged 35-64 years, BMI 18-28 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly allocated into two groups: the flurbiprofen axetil group (group F) and the control group (group C), 30 patients in each group. In group F, flurbiprofen axeil 1.0 mg/kg was injected intravenously 15 minutes before anesthesia induction, while group C was not treated. Blood gas analysis was performed in 2 ml of radial artery 20 minutes before anesthesia induction (T₀), 30 minutes (T₁) and 60 minutes (T₂) after OLV, and 15 minutes (T₃) after two lung ventilation, then oxygenation index (OI) was calculated respectively and SpO₂ was recorded. Parameters of lung mechanics were monitored at T₁ and T₂ including peak airway pressure (Ppeak), airway platform pressure (Pplat), dynamic lung compliance (Cdyn), and ratio of null lumen volume to tidal volume (V_D/V_T). The incidence of hypoxemia and the number of remedial cases during OLV were recorded. The postoperative transfer to ICU and complications such as atelectasis, acute lung injury and pneumonia within 72 hours after surgery were recorded.
Results: Compared with group C, SpO₂ at T₁, PaO₂ and OI at T₁—T₃, and Cdyn at T₁ and T₂ were significantly increased in group F (P < 0.05), Ppeak and V_D/V_T at T₁ and T₂, Pplat at T₂ were significantly decreased in group F (P < 0.05). There were no hypoxemia and remedies occurred during OLV and no patients were transferred to ICU after surgery, no atelectasis, acute lung injury, and pneumonia occurred within 72 hours after surgery between the two groups.
Conclusion: For patients undergoing OLV with endobronchial blockers undergoing thoracoscopic right lung lobectomy, intravenous flurbiprofen axetil before induction of anesthesia can help improve lung oxygenation and optimize respiratory parameters during one lung ventilation.