摘要：
Objective To evaluate the lung protection of flurbiprofen axetil combined with protective mechanical ventilation in the patients undergoing thoracic surgery.Methods Sixty patients of both sexes,aged 25-64 yr,with body mass index of 18-29 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of esophageal cancer under general anesthesia,were randomly divided into 4 groups (n =15 each) using a random number table:conventional mechanical ventilation (group CMV),flurbiprofen axetil combined with conventional mechanical ventilation group (group F+CMV),protective mechanical ventilation group (group PMV),and flurbiprofen axetil combined with protective mechanical ventilation group (group F+PMV).Volume-controlled ventilation was performed in the 4 groups.Conventional mechanical ventilation mode was as follows:tidal volume (VT) 10 ml/kg and respiratory rate (RR) 10-12 breaths/min during two-lung ventilation (TLV);VT 8 ml/kg and RR 15-18 breaths/min during one-lung ventilation (OLV).Protective mechanical ventilation mode was as follows:VT 6 ml/kg,positive end-expiratory pressure 5 cmH2O,RR 15-18 breaths/min (during OLV) or 10-12 breaths/min (during TLV),inspiratory/expiratory ratio 1:2,fraction of inspired oxygen 100％,oxygen flow rate 1-2 L/min.The end-tidal pressure of carbon dioxide was maintained at 3545 mmHg in the 4 groups.Flurbiprofen axetil 2 mg/kg was injected intravenously at 15 min before skin incision,and the patient-controlled intravenous analgesia (PCIA) was used after surgery.PCIA solution contained sufentanil 100 μg and flurbiprofen axetil 2 mg/kg in 100 ml of normal saline.The PCIA pump was set up with a 0.5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h,and visual analogue scale score was maintained ≤ 3.Before induction of anesthesia (T0),at 15 min of TLV (T1),at 1 and 2 h of OLV (T2),at 2 h after OLV (T3),at the end of surgery (T4),and at 24hafter surgery (T5),blood samples were taken from the radial artery for determination of arterial oxygen partial pressure,and oxygenation index was calculated.The occurrence of abnormal pulmonary function was recorded during and after surgery.The parameters of pneumodynamics were recorded at T1-4.Central venous blood samples were taken at T0,4,5 to measure the concentrations of tumor necrosis factor-alpha,interleukin6 (IL-6),and IL-8 in serum.Results Compared with group CMV,arterial oxygen partial pressure,oxygenation index,and dynamic lung compliance were significantly increased,the peak airway pressure,airway plateau pressure and concentrations of tumor necrosis factor-alpha,IL-6,and IL-8 in serum were significantly decreased,and the incidence of abnormal pulmonary function after surgery was significantly decreased in the other 3 groups,especially in group F+PMV (P＜0.05).Conclusion Flurbiprofen axetil used before and after surgery has lung protection,and it produces better efficacy when combined with protective mechanical ventilation in the patients undergoing thoracic surgery.%目的 评价氟比洛芬酯及其联合保护性机械通气对开胸手术病人的肺保护作用.方法 择期于全麻下行食管癌根治术病人60例,年龄25 ～ 64岁,性别不限,BMI 18～ 29 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为4组(n=15):常规机械通气组(CMV组)、氟比洛芬酯+常规机械通气组(F+CMV组)、保护性机械通气组(PMV组)和氟比洛芬酯联合保护性机械通气组(F+PMV组).4组均采用容量控制通气模式,常规机械通气参数:双肺通气时VT 10 ml/kg,通气频率10～12次/min,单肺通气时VT8 ml/kg,通气频率15～18次/min;保护性机械通气参数:VT6 ml/kg,PEEP 5 cmH2O,单肺通气和双肺通气时通气频率分别为15～18次/min和10～12次/min;4组I:E为1:2,FiO2 100％,氧流量1～2 L/min,维持PETCO2 35～45 mmHg.氟比洛芬酯给药方案:于切皮前15min时静脉注射氟比洛芬酯2 mg/kg,术后行PCIA,PCIA配方为舒芬太尼100μg混合氟比洛芬酯2mg/kg,用生理盐水稀释至100 ml;背景输注速率2 ml/h,PCA剂量0.5 ml,锁定时间15 min,镇痛至术后24 h,维持VAS评分≤3分.分别于麻醉诱导前、双肺通气15 min、单肺通气1h、2h、术毕、术后24 h时采集桡动脉血样,测定PaO2,并计算氧合指数,记录术中及术后肺功能异常的发生情况;分别于T1-4时记录呼吸动力学指标;分别于T0,45时采集中心静脉血样,测定血清TNF-α、IL-6和IL-8的浓度.结果 与CMV组比较,其它3组PaO2、氧合指数和动态肺顺应性升高,气道峰压、气道平台压和血清TNF-α、IL-6和IL-8的浓度降低,术后肺功能异常率降低,F+PMV组更明显(P＜0.05).结论 术前及术后应用氟比洛芬酯对开胸手术病人具有肺保护作用,其联合保护性机械通气的效果更好.
