Choi Hoon, Jeon Joonpyo, Huh Jaewon, Koo Jungmin, Yang Sungwon, Hwang Wonjung
Department of Anesthesia and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea.
Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 93-6, Jingwan-dong, Eunpyeong-gu, Seoul 122200, Republic of Korea.
J Clin Med. 2019 Jul 5;8(7):982. doi: 10.3390/jcm8070982.
Hypoxemia can occur during one-lung ventilation (OLV) in thoracic surgery, leading to perioperative complications. Inhaled iloprost is a selective pulmonary vasodilator with efficacy in patients with pulmonary hypertension. The purpose of this study was to evaluate the effects of off-label inhaled iloprost on oxygenation during OLV in patients undergoing lung surgery. Seventy-two patients who were scheduled for elective video-assisted thoracoscopic lobectomy were assigned to receive an inhaled nebulizer of distilled water (control group), 10 μg iloprost (IL10 group), or 20 μg iloprost (IL20 group). Arterial and venous blood gas and hemodynamic analyses were obtained. Changes in partial pressure of oxygen in arterial blood (PaO), after the initiation of OLV and the resumption two-lung ventilation (TLV), were similar in all three groups. However, PaO in the IL10 group was comparable to that in the control group, whereas PaO in the IL20 group was significantly higher than that in the control group at 10, 20, and 30 min after administration of iloprost (275.1 ± 50.8 vs. 179.3 ± 38.9, < 0.0001; 233.9 ± 39.7 vs. 155.1 ± 26.5, < 0.0001; and 224.6 ± 36.4 vs. 144.0 ± 22.9, < 0.0001, respectively). The shunt fraction in the IL20 group was significantly higher than that in the control group after administration of iloprost (26.8 ± 3.1 vs. 32.2 ± 3.4, < 0.0001; 24.6 ± 2.2 vs. 29.9 ± 3.4, < 0.0001; and 25.3 ± 2.0 vs. 30.8 ± 3.1, < 0.0001, respectively). Administration of inhaled iloprost during OLV improves oxygenation and decreases intrapulmonary shunt.
在胸外科手术的单肺通气（OLV）期间可能会发生低氧血症，从而导致围手术期并发症。吸入伊洛前列素是一种选择性肺血管扩张剂，对肺动脉高压患者有效。本研究的目的是评估超说明书使用吸入伊洛前列素对肺手术患者OLV期间氧合的影响。72例计划接受选择性电视辅助胸腔镜肺叶切除术的患者被分配接受蒸馏水吸入雾化器（对照组）、10μg伊洛前列素（IL10组）或20μg伊洛前列素（IL20组）。进行了动脉和静脉血气及血流动力学分析。在OLV开始后和恢复双肺通气（TLV）后，三组患者动脉血中氧分压（PaO）的变化相似。然而，IL10组的PaO与对照组相当，而在给予伊洛前列素后10、20和30分钟时，IL20组的PaO显著高于对照组（分别为275.1±50.8对179.3±38.9，<0.0001；233.9±39.7对155.1±26.5，<0.0001；224.6±36.4对144.0±22.9，<0.0001）。给予伊洛前列素后，IL20组的分流分数显著高于对照组（分别为26.8±3.1对32.2±3.4，<0.0001；24.6±2.2对29.9±3.4，<0.0001；25.3±2.0对30.8±3.1，<0.0001）。在OLV期间吸入伊洛前列素可改善氧合并减少肺内分流。
