化疗后肺癌病人单肺通气时氧自由基、IL-6、IL-8和TNF-α的变化和乌司他丁的保护作用

The Effects of Ulinastatin on Oxygen Free Radical and IL-6、IL-8、TNF-a During One Lung Ventilation after Chemotherapy to Patients with Lung Cancer

目的 探讨化疗后肺癌病人单肺通气时氧自由基、IL 6、IL 8和TNF α的变化和乌司他丁的保护作用。方法 择期行肺癌手术病人 30例 ,按美国麻醉医师协会 (ASA)分级为Ⅱ～Ⅲ级 ;随机分为乌司他丁组 (U组 )和对照组 (C组 ) ,每组各 15例。U组给予乌司他丁 1万U·kg-1,于麻醉诱导后缓慢静注 ,C组用等量生理盐水代替。分别于麻醉诱导后 (S1)、单肺通气 4 0min(S2 )、单肺通气 90min(S3 )、术毕双肺通气 30min(S4)、术后 2 4h(S5)采集外周静脉血样测SOD、MDA、IL 6、IL 8和TNF α。结果 C组SOD在S3 、S4时明显降低 (P <0 .0 5 ) ,U组从S2 开始升高 ,且U组在S3 、S4时均明显高于C组 (P <0 .0 5 ) ;两组MDA于S3 、S4时均显著升高 (P <0 .0 5 ) ,但两组之间无明显差别。两组IL 6于S2 后均显著升高 (P <0 .0 5 ) ,和C组比较 ,U组S3 、S4时均显著降低 (P <0 .0 5 )。两组IL 8于S3 、S4、S5时均显著升高 (P <0 .0 5 ) ,和C组比较 ,U组S3 、S4时均显著降低 (P <0 .0 5 )。两组TNF α于S2 、S3 、S4时均显著升高 (P <0 .0 5 ) ,和C组比较 ,U组S3 时均显著降低 (P <0 .0 5 )。结论 乌司他丁可减轻化疗后病人单肺通气期间炎性因子的生成和释放 ,减少氧自由基的产生 。

Objective To investigate the effects of ulinastatin on oxygen free radical,IL 6,IL 8 and TNF a during one lung ventilation after chemotherapy to patients with lung cancer.Methods Thirty pulmonary surgery candidates with lung cancer after chemotherapy and ASA Ⅱ～ Ⅲ were randomized to ulinastatin group (group U, n =15) and controlled group (group C, n =15. Group U: Patients received ulinastatin 10000U·kg -1 iv after induction of anesthesia. Group C: Patients received equal volume of normal saline instead of ulinastatin. Blood concentrations of SOD, MDA, IL 6, IL 8 and TNF α were tested at post induction of anesthesia(S 1);40 min after one lung ventilation in the lateral position(S 2); 90 min after one lung ventilation in the lateral position(S 3); 30 min after two lung ventilation at the end of the operation(S 4); 24h after operation (S 5).Results SOD activity decreased significantly in group C and was lower at S 3 4 than group U. The plasma level of MDA increased in both group but there was no significant difference between the two group. Plasma IL 6 concentrations were lower at S 3 4 in group U than group C( P < 0.05 ). Plasma IL 8 concentrations increased significantly at S 3 5 in both group as compared with the baseline value and were significantly lower at S 3 4 in group U than group C( P < 0.05 ). Plasma TNF α concentrations were lower at S 3 in group U than group C( P < 0.05 ).Conclusion Ulinastatin can effectively decrease the level of plasma IL 6, IL 8 and TNF α, and modulate the production of oxygen free radical and attenuate the systemic inflammatory response.