摘要目的 评价氟比洛芬酯不同给药时机对单肺通气患者氧合功能的影响.方法 择期行胸腔镜肺叶切除术患者90例,性别不限,年龄45 ～ 64岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=30):对照组(C组)、术前给药组(F1组)和术中给药组(F2组).C组和F1组分别于术前15 min静脉注射脂肪乳剂和氟比洛芬酯(10 mg/ml)各10 ml.F2组于单肺通气开始即刻静脉注射氟比洛芬酯10 ml.于术前15 min(T1)、单肺通气15 min(T2)、单肺通气30 min(T3)、恢复双肺通气15min(T4)时记录气道峰压(Ppeak)及动态肺顺应性(Cdyn),取动脉血标本,进行血气分析,记录动脉血氧分压(PaO2),计算氧合指数(OI)和肺内分流率(Qs/Qt);采用ELISA法测定血清血栓素B2(TXB2)和6-酮-前列腺素1α(6-K-PGF1α)浓度,计算TXB2/6-K-PGF1α比值;记录因SpO2＜ 90％中断单肺通气的发生情况和术后呼吸困难、肺部感染、肺不张的发生情况和住院时间.结果 与C组比较,F1组T2,3时PaO2和OI升高,Qs/Qt降低,T2～4时血清TXB2和6-K-PGF1α浓度降低,TXB2/6-K-PGF1仪比值升高,中断单肺通气发生率降低(P＜0.05),F2组上述指标差异无统计学意义(P＞0.05).与F1组比较,F2组T2,3时PaO2和OI降低,T2时Qs/Qt升高,T2～4时血清TXB2和6-K-PGF1α浓度升高,TXB2/6-K-PGF1α比值降低(P＜0.05).3组术后呼吸困难、肺部感染、肺不张发生率及术后住院时间比较差异无统计学意义(P＞0.05).结论 术前15 min静脉注射氟比洛芬酯可显著改善单肺通气患者氧合功能,预防低氧血症的发生,而于单肺通气开始时给药则无此效应.

abstractsObjective To evaluate the effects of flurbiprofen axetil administered at different time points on oxygenation in the patients undergoing one-lung ventilation (OLV).Methods Ninety patients of both sexes,aged 45-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective thoracoscope-assisted pulmonary lobectomy,were assigned into 3 groups (n =30 each) using a random number table:control group (group C),preoperative administration group (group F1) and intraoperative administration group (group F2).Flurbiprofen axetil (10 mg/ml) and fat emulsion 10 ml were injected intravenously at 15 min before operation in F1 and C groups,respectively.Flurbiprofen axetil 10 ml was intravenously injected immediately after the beginning of OLV in group F2.At 15 min before operation (T1),15 and 30 min of OLV (T2,3),and 15 min after restoration of two-lung ventilation (T4),airway peak pressure (Ppeak) and dynamic lung compliance (Cdyn) were recorded,arterial blood samples were collected for blood gas analysis.The arterial oxygen partial pressure (PaO2) was recorded,and the oxygenation index (OI) and intrapulmonary shunt (Qs/Qt) were calculated.The concentrations of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α (6-K-PGF1α) in serum were measured by enzyme-linked immunosorbent assay,and TXB2/6-K-PGF1α ratio was calculated.The development of interrupting OLV due to SpO2＜90％ and postoperative dyspnea,pulmonary infection,atelectasis and length of hospital stay were recorded.Results Compared with group C,PaO2 and OI were significantly increased,and Qs/Qt was decreased at T2,3,the serum concentrations of TXB2 and 6-K-PGF1α were decreased,and TXB2/6-K-PGF1α ratio was increased at T2-4,the incidence of interrupting OLV was decreased (P＜0.05),and no significant change was found in the parameters mentioned above in group F2 (P＞0.05).Compared with group F1,PaO2 and OI were significantly decreased at T2,3,Qs/Qt was increased at T2,and the serum concentrations of TXB2 and 6-K-PGF1α were increased,and TXB2/6-K-PGF1α ratio was decreased at T2-4 in group F2 (P＜0.05).There was no significant difference in the incidence of postoperative dyspnea,pulmonary infection and atelectasis and length of hospital stay between the three groups (P＞0.05).Conclusion Flurbiprofen axetil injected at 15 min before operation can significantly improve oxygenation and prevent the development of hyoxemia in the patients undergoing OLV,however,flurbiprofen axetil administered immediately after the beginning of OLV has no such effect.