在单肺通气期间通过向通气肺选择性输注前列腺素E1改善动脉氧合。

Improvement of arterial oxygenation by selective infusion of prostaglandin E1 to ventilated lung during one-lung ventilation.

作者信息

Chen T L, Ueng T H, Huang C H, Chen C L, Huang F Y, Lin C J

机构信息

Department of Anaesthesia, National Taiwan University Hospital, Republic of China.

出版信息

Acta Anaesthesiol Scand. 1996 Jan;40(1):7-13. doi: 10.1111/j.1399-6576.1996.tb04381.x.

DOI:10.1111/j.1399-6576.1996.tb04381.x

PMID:8904253

Abstract

BACKGROUND

One-lung anesthesia provides a better surgical field for thoracic procedures but also impairs the arterial oxygenation and venous admixture. During one-lung ventilation, pulmonary vasoconstriction is assumed to be present within both ventilated and collapsed lungs. We propose that arterial oxygenation could be optimized by offsetting the vasoconstriction within the microcirculation of ventilated lung.

METHOD

In an anesthetized dog model, incremental doses of prostaglandin E1 (PGE1) were selectively infused into the main trunk of the pulmonary artery of the ventilated lung after one-lung ventilation for 60 min (PGE1 group, n = 9). Arterial oxygenation and calculated venous admixture (Qs/Qt) was also assessed in a time-course control group (Control group, n = 5). During two-lung ventilation (FIO2: 0.66), arterial PO2 and venous admixture was 44.2 +/- 3.5 kPa and 10.7 +/- 2.3%, respectively. One-lung ventilation (FIO2: 0.66) with left lung collapsed reduced arterial PO2 to 11.6 +/- 1.7 kPa and increased venous admixture to 40.7 +/- 5.8% (P<0.001). Venous O2 tension also decreased from 6.3 +/- 0.7 kPa to 5.0 +/- 0.6 kPa with a slight increase in mean pulmonary artery pressure and pulmonary vascular resistance (P<0.05).

RESULTS

During selective infusion of PGE1 at a dose of 0.04 to 0.2 mu g kg-1 min-1, there was a dose-dependent improvement in arterial PO2 with a parallel reduction of venous admixture during one-lung ventilation. Arterial PO2 increased to a maximum of 23.0 +/- 4.3 kPa, and the venous admixture decreased significantly to a minimum of 27.4 +/- 4.2% by PGE1 at a dose of 0.04-0.4 mu g kg-1 min-1 (P<0.01). PGE1 resulted in a small increase in cardiac output and decreases of pulmonary pressure and pulmonary vascular resistance at a relatively high dose of 0.4 mu g kg-1 min-1 during selective infusion (P<0.05).

CONCLUSIONS

These results suggest that a selective pulmonary artery infusion of PGE1 to the ventilated lung within the dose range of 0.04-0.4 mu g kg-1 min-1 is practical and effective to improve arterial oxygenation and reduce venous admixture during one-lung ventilation.

摘要

背景

单肺麻醉可为胸科手术提供更好的手术视野，但也会损害动脉氧合和静脉血掺杂。在单肺通气期间，通气肺和萎陷肺内均假定存在肺血管收缩。我们提出，通过抵消通气肺微循环内的血管收缩，可优化动脉氧合。

方法

在麻醉犬模型中，单肺通气60分钟后，将递增剂量的前列腺素E1（PGE1）选择性注入通气肺的肺动脉主干（PGE1组，n = 9）。还在一个时间进程对照组（对照组，n = 5）中评估动脉氧合和计算的静脉血掺杂（Qs/Qt）。在双肺通气期间（吸入氧分数：0.66），动脉血氧分压和静脉血掺杂分别为44.2±3.5 kPa和10.7±2.3%。左肺萎陷的单肺通气（吸入氧分数：0.66）使动脉血氧分压降至11.6±1.7 kPa，并使静脉血掺杂增加至40.7±5.8%（P<0.001）。静脉血氧张力也从6.3±0.7 kPa降至5.0±0.6 kPa，同时平均肺动脉压和肺血管阻力略有增加（P<0.05）。

结果

在以0.04至0.2μg·kg-1·min-1的剂量选择性输注PGE1期间，单肺通气时动脉血氧分压呈剂量依赖性改善，同时静脉血掺杂并行减少。动脉血氧分压最高升至23.0±4.3 kPa，在剂量为0.04 - 0.4μg·kg-1·min-1的PGE1作用下，静脉血掺杂显著降至最低27.4±4.2%（P<0.01）。在选择性输注期间，PGE1在相对高剂量0.4μg·kg-1·min-1时导致心输出量略有增加，肺动脉压和肺血管阻力降低（P<0.05）。