单肺通气期间雾化吸入与静脉注射前列环素的血流动力学及肺部效应

[Aerosolized and intravenous prostacyclin during one-lung ventilation. Hemodynamic and pulmonary effects].

作者信息

Bund M, Henzler D, Walz R, Rossaint R, Piepenbrock S, Kuhlen R

机构信息

Klinik für Anästhesiologie, Albert-Schweitzer-Krankenhaus, Northeim.

出版信息

Anaesthesist. 2004 Jul;53(7):612-20. doi: 10.1007/s00101-004-0683-3.

DOI:10.1007/s00101-004-0683-3

PMID:15085285

Abstract

BACKGROUND

One-lung ventilation is frequently used in thoracic surgery. However, hypoxic pulmonary vasoconstriction of the atelectatic lung may produce pulmonary hypertension. The objective of the present study was to compare the acute effects of intravenous versus aerosolized prostacyclin (PGI(2)) on pulmonary and systemic circulation.

METHODS

PGI(2) was administered in 11 anesthetized and unilaterally ventilated pigs by infusion (5, 10, and 20 ng/kg body weight/min) and by inhalation (4, 8, and 16 ng/kg body weight/min) in a cross-over design.

RESULTS

Infusion of PGI(2) reduced both pulmonary (PVR) and systemic vascular resistance (SVR). Due to a concomitant increase in cardiac index (CI) mean arterial (MAP) and pulmonary artery pressures (MPAP) did not change significantly. In contrast, aerosolized PGI(2) produced a significant decrease in PVR (-21.4 to -32.8%) and MPAP (-12.0 to -17.8%) without affecting SVR, MAP, and CI. Arterial oxygenation tension (p(a)O(2)) was not affected.

CONCLUSION

During one-lung ventilation only aerosolized prostacyclin produced a selective pulmonary vasodilation.

摘要

背景

单肺通气常用于胸外科手术。然而，肺不张肺的低氧性肺血管收缩可能会导致肺动脉高压。本研究的目的是比较静脉注射与雾化吸入前列环素（PGI₂）对肺循环和体循环的急性影响。

方法

采用交叉设计，对11只麻醉并单侧通气的猪分别通过输注（5、10和20 ng/kg体重/分钟）和吸入（4、8和16 ng/kg体重/分钟）给予PGI₂。

结果

输注PGI₂可降低肺血管阻力（PVR）和体循环血管阻力（SVR）。由于心指数（CI）同时增加，平均动脉压（MAP）和肺动脉压（MPAP）无明显变化。相比之下，雾化吸入PGI₂可使PVR显著降低（-21.4%至-32.8%），MPAP显著降低（-12.0%至-17.8%），而不影响SVR、MAP和CI。动脉血氧分压（p(a)O₂）不受影响。