目的 探讨右美托咪定联合七氟烷吸入对胸腔镜下肺叶切除患者单肺通气肺损伤的影响.方法 将拟行择期肺叶切除术的80例患者,采用随机数字表法分为4组:右美托咪定组(D组)、七氟烷组(S组)、右美托咪定联合七氟烷吸入组(DS组)和生理盐水对照组(C组).4组采用相同的快速麻醉诱导播管方式,S组和DS组于插管后吸入1％～2％七氟醚;D组与DS组于麻醉诱导前经静脉泵注1.0 μg/kg负荷剂量的右美托咪定(10 min内输注完毕),而后以0.4 μg·kg-1·h-1的速率输注至手术结束;C组静脉泵注等量的生理盐水.分别于双肺通气15 min (T1)、单肺通气1 h(T2)及恢复双肺通气15 min(T3)记录气道平台压,计算肺动态顺应性;并采集动脉血样行血气分析,计算氧合指数;采集外周静脉血样,用酶联免疫吸附试验(ELISA)法测定血清中肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平;记录术后肺功能异常的发生情况及住院时间.结果 与T1时比较,T2、T3时4组气道平台压明显升高,肺动态顺应性和氧合指数明显降低,血清IL-6和TNF-α水平明显升高(P＜0.05);与C组比较,D组、S组和DS组在T2和T3时气道平台压明显降低,肺动态顺应性和氧合指数明显升高,血清IL-6和TNF-α水平明显降低,术后肺部并发症减少及住院时间缩短(P＜0.05);与D组比较,DS组在T2和T3时气道平台压明显降低,肺动态顺应性和氧合指数明显升高,血清IL-6和TNF-α水平明显降低,术后肺部并发症减少及住院时间缩短(P＜0.05);与S组比较,DS组在T2和T3时气道平台压明显降低,肺动态顺应性和氧合指数明显升高,血清IL-6和TNF-α水平明显降低,术后肺部并发症减少及住院时间缩短(P＜0.05).结论 右美托咪定联合七氟烷吸入在胸腔镜下肺叶切除术中单肺通气时具有肺保护作用,较单独使用效果更好.

[Purpose] To explore the value of two-dimension ultrasound(2D),color doppler flow imaging(CDFI),pulse wave doppler(PW) and three-dimension color power angiography(3D-CPA) in differentiating malignant from benign thyroid nodules.[Methods] The ultrasonography features including 2D,CDFI,PW and 3D-CPA finding in 89 cases with thyroid nodules were analyzed and compared with pathological results.[Results] There were significant difference between malignant and benign thyroid nodules in boundary,appearance,calcification,acoustic halo,blood grading,PSV and RI.3D-CPA combined with CDFI could clearly show the blood feature of thyroid nodules.[Conclusion] Combination of 2D,CDFI,PW and 3D-CPA images can improve the diagnostic accuracy for thyroid nodules.