胸内手术患者单肺通气时超氧化物歧化酶的变化及意义

摘要

目的 探讨胸内手术患者单肺通气时超氧化物歧化酶(SOD)的变化及意义.方法 剖胸手术患者30例,随机分为两组,单肺通气组(OLV组)15例和双肺通气组(TLV组)15例,于麻醉诱导前(T0)、单肺通气前即刻(T1)、单肺通气0.5 h(T2)、1 h(T3)、2 h(T4)、恢复双肺通气1 h(T5)、2 h(T6)和术后24 h(T7),双肺通气组T1～7对应时点为手术剖开胸腔时、胸内操作0.5 h 、1 h、2 h、胸内操作完成后1 h、2 h,术后24 h,采集桡动脉血样,测定血清SOD的活性,白细胞(WBC)和中性粒细胞(PMN)计数.结果 与T0比较,两组的SOD活性均在T5、T6下降(P＜0.05);WBC及PMN计数:OLV组在T4～T7、TLV组T5～T7升高(P＜0.05).与TLV组比较,OLV组T5～T7时SOD活性降低,PMN计数升高,T4～T7时WBC计数升高(P＜0.05).结论 单肺通气比双肺通气更易诱发或加重机体的氧化应激反应.%Objective To investigate the change and significance of superoxide dismutase( SOD ) during one-lung ventilation in patients undergoing thoracic surgery. Methods Thirty cases undergoing thoracic surgery were divided into two groups randomly, one lung ventilation group( n = 15 ,OLV group ) and two-lung ventilation group( n = 15 ,TLV group ). Theactivity of SOD,white blood cell( WBC ) and polymorphonuclear neutrophils( PMN ) counts were detected before induction of anesthesia( T0 ),at the moment of one-lung ventilation( T1 ),0. 5 houi( T2 ),1 houi( T3 ),2 hours( T4 ) after one-lung ventilation, 1 houi( T5 ),2 hours( T6 ) after the recovery of two-lung ventilation and 24 hours( T7 ) after the surgery in OLV group,and the detection was also performed in the TLV group at the moment of opening chest( T1 ),30 minutes ( T2 ), 1 hour( T3 ) ,2 hours( T4 ) after beginning of surgery and 1 hour( T5 ) ,2 hours( T6 ) ,24 hours( T7 ) after the end of surgery. Results Compared with T0, the activity of SOD decreased at T5 and T6 in the two groups( P < 0.05 ); WBC and PMN increased at T4 - T7 in OLV group and at T5 - T7 in TLV group( P < 0.05 ). Compared with TLV group, the activity of SOD decreased at T5 - T7 in OLV group, while PMN increased; WBC increased at T4 - T7( P < 0. 05 ). Conclusion Compared with two-lung ventilation, one-lung ventilation stimulates and aggravates oxidative stress of organism much more easily.