Chen T L, Lee Y T, Wang M J, Lee J M, Lee Y C, Chu S H
Department of Anaesthesia, National Taiwan University Hospital, Taipei, Republic of China.
Anaesthesia. 1996 May;51(5):422-6. doi: 10.1111/j.1365-2044.1996.tb07783.x.
In order to improve arterial oxygenation and venous admixture during one lung ventilation, the effect of selective infusion of prostaglandin E1 into the pulmonary artery of the ventilated lung was investigated in 12 adult patients undergoing thoracotomy. Patients' bronchi were intubated with a Mallinckrodt bronchial tube and ventilated with 66% oxygen in air. Cardiopulmonary factors such as systemic and pulmonary arterial pressures, pulmonary vascular resistance, blood gas analyses, cardiac output and airway pressure were measured before and during one-lung ventilation; venous admixture (Qs/Qt) was calculated. Serial blood samples were taken from the pulmonary artery of the ventilated lung for endothelin-1 estimation. One lung ventilation reduced the mean PaO2 from 42.1 (2.3) kPa to 11.8 (1.4) kPa (p < 0.001) and increased Qs/Qt from 10.8 (3.2)% to 39.2 (4.7)% (p < 0.001). Pulmonary vascular resistance also increased from 167 (24) dyne.s.cm-5 to 262 (38) dyne.s.cm-5 (p < 0.05) with a corresponding increase of plasma endothelin-1 (p < 0.05). After 30 min of one lung ventilation, PGE1 was infused continuously into the pulmonary artery of the ventilated lung at a rate which increased incrementally from 0.04-0.10 micrograms.kg-1.min-1. PaO2 increased to 20.7 (2.6) kPa (p < 0.01) and Qs/Qt decreased to 30.6 (3.5)% (p < 0.05). During the infusion, pulmonary vascular resistance reduced to 173 (30) dyne.s.cm-5 (p < 0.01). The plasma endothelin-1 concentration reached a plateau between the end of one lung ventilation (before closing the thorax) and 6 h postoperatively. This correlated inversely with the pre-operative forced expiratory volume in one second (r = -0.68, p < 0.005), declining to normal values 72 h after operation. The selective infusion of PGE1 into the pulmonary artery of the ventilated lung corrected pulmonary vasoconstriction and improved both arterial oxygenation and venous admixture during one lung ventilation for thoracotomy.
为了改善单肺通气期间的动脉氧合和静脉血掺杂，对12例接受开胸手术的成年患者进行研究，观察选择性向通气肺的肺动脉内输注前列腺素E1的效果。患者的支气管用Mallinckrodt支气管导管插管，并使用含66%氧气的空气进行通气。在单肺通气前和通气期间测量心肺相关因素，如体循环和肺动脉压、肺血管阻力、血气分析、心输出量和气道压力；计算静脉血掺杂（Qs/Qt）。从通气肺的肺动脉采集系列血样以测定内皮素-1。单肺通气使平均动脉血氧分压（PaO2）从42.1（2.3）kPa降至11.8（1.4）kPa（p<0.001），并使Qs/Qt从10.8（3.2）%增加至39.2（4.7）%（p<0.001）。肺血管阻力也从167（24）达因·秒·厘米⁻⁵增加至262（38）达因·秒·厘米⁻⁵（p<0.05），同时血浆内皮素-1相应增加（p<0.05）。单肺通气30分钟后，以0.04 - 0.10微克·千克⁻¹·分钟⁻¹的速率递增持续向通气肺的肺动脉内输注前列腺素E1。PaO2升至20.7（2.6）kPa（p<0.01），Qs/Qt降至30.6（3.5）%（p<0.05）。在输注过程中，肺血管阻力降至173（30）达因·秒·厘米⁻⁵（p<0.01）。血浆内皮素-1浓度在单肺通气结束时（关闭胸腔前）至术后6小时达到平台期。这与术前一秒用力呼气量呈负相关（r = -0.68，p<0.005），术后72小时降至正常水平。选择性向通气肺的肺动脉内输注前列腺素E1可纠正肺血管收缩，并改善开胸手术单肺通气期间的动脉氧合和静脉血掺杂。
